Roll Up Your Sleeve Flu Shot Gift Card Form

Roll Up Your Sleeve Flu Shot Gift Card program

Starting September 1, 2020, we’re offering Arizona Department of Health Services’ (ADHS) Roll Up Your Sleeve Flu Shot Gift Card program. Through this program, every member will get a $10 gift card when you get your flu shot.

To get your $10 gift card, follow these three easy steps:

  1. Make an appointment with your provider or go to your local pharmacy or clinic and get a flu shot
  2. Fill out the Flu Shot Gift Card Form. If you need help completing the form, call Member Services at 1-800-424-5891 (TTY 711).
  3. Be sure to have your AHCCCS ID number, the name of the provider, pharmacy or clinic where you got your flu shot and the date you got your flu shot

Once MCC of AZ receives your flu shot claim, we’ll send you a gift card in the mail. It may take up to six months for us to receive the claim from the provider.  We will mail your $10 gift card to you as soon as we can.

If you haven’t received your gift card in the mail after six months or if you have any questions, please call Member Services at 1-800-424-5891 (TTY 711). We’re available Monday through Friday from 8 a.m. to 6 p.m. local time.

Flu Shot Gift Card Form

(Where you want us to mail your gift card)

(If applicable)

(Name of Provider/Pharmacy/Clinic where flu shot was given)