Serving the Episcopal Church and Its People
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Please contact Client Services at (855) 594-2201, Monday - Friday, 8:30AM - 8:00PM ET (excluding holidays).
The Episcopal Church Medical Trust19 East 34th StreetNew York, NY 10016
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Email: firstname.lastname@example.orgOr fax to:212-592-9470
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The Episcopal Church Medical Trust19 East 34th Street, New York, NY, 10016; or fax to (212) 251-8891
Express Scripts, Inc.P.O. Box 66583St. Louis, MO 63166-6583ATTN: NGC STD ACCTS
Express ScriptsATTN: Medicare Part DP.O. Box 14718Lexington, KY 40512-4718FAX: (608) 741-5483
EyeMed Vision CareAttn: OON ClaimsP.O. Box 8504Mason, OH 45040-7111
Episcopal Church Medical TrustTravel Protection Benefit CoordinatorPO Box 2745New York, NY 10163
Member ServicesThe Episcopal Church Medical Trust19 East 34th StreetNew York, NY 10016
RETURN THIS COMPLETED FORM TOMedical Trust:The Episcopal Church19 East 34th StreetNew York, NY 10016Fax: (212) 592‐4234Email: email@example.com
JoAnn Goetz,Clinical ManagementThe Episcopal Church Medical Trust19 East 34th StreetNew York, NY 10016Confidential Fax: (212) 592-1831
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