| For Eligible Participants of the UFCW Local 1776 and Participating Employers Health and Welfare Fund |
| Plan administered by: UFCW Local 1776 and Participating Employers Health & Welfare Fund |
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GVA Provider Directory Revised 6/5/08 |
| Delaware |
| Pennsylvania |
| New Jersey |
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Important Note! To use the Plan, you must contact the Fund office for a claim form and to determine your vision benefit eligibility. Claim form must be presented to a participating doctors on your first visit. |