First Fill Information

SFM myMatrixx First Fill Form

Pharmacy Locator

The MyMatrixx pharmacy network includes all major pharmacy chains as well as most regional and independent pharmacies, including Albertson’s, Costco, CVS, Duane Reade, Hy-Vee, Meijer, Publix, Raley’s, Rite Aid, Safeway, Walgreens, Walmart, and Wegmans.

FIND A PHARMACY NEAR YOU

To the Pharmacist

MyMatrixx by Evernorth, administers this workers’ compensation prescription program. Please follow the steps below to submit a prescription claim. Standard first fill shall not exceed a 30-day supply or a cost of $750. This information is valid for up to 30 days from date of injury (DOI). Limitations may vary. For assistance, call MyMatrixx Customer Care at 1-877-804-4900.

Pharmacy Processing Steps

  1. Enter BIN number: 003858
  2. Enter processor control: WC
  3. Enter the group number: F2SA
  4. Enter the injured worker’s nine digit ID number (SSN provided by the injured worker)
  5. Enter the injured worker’s first and last name
  6. Enter the injured worker’s date of injury (mm/dd/yyyy)