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Office: 910-509-7137
Cell: 910-620-4641

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Rx Drug Lookup

Complete the below form and a Benefit Specialist will contact you as soon as possible

First name*

Last name*

Email*

Phone Number*

Zip Code*

Preferred Pharmacy

Medications

Drug Name

Dosage

# Per Day

Drug Name

Dosage

# Per Day

Drug Name

Dosage

# Per Day

Drug Name

Dosage

# Per Day

Drug Name

Dosage

# Per Day

Drug Name

Dosage

# Per Day

Drug Name

Dosage

# Per Day

Drug Name

Dosage

# Per Day

Drug Name

Dosage

# Per Day

Drug Name

Dosage

# Per Day

Providers

Provider's Name

Specialty

Provider's Name

Specialty

Provider's Name

Specialty

Provider's Name

Specialty

Provider's Name

Specialty

By submitting this form, you consent for a licensed insurance agent from Chelsea Insurance Group LLC to contact you via phone or email regarding insurance options. This communication is for insurance purposes only.

Contact Us

Landfall Executive Suites

1213 Culbreth Drive

Suite 224

Wilmington, NC 28405

Ken 910-509-7138

ken@chelseainsurancegrp.com

Sarah 910-620-4641

sarah@chelseainsurancegrp.com

© 2025 Chelsea Insurance Group. All rights reserved.

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