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Sufficient information is necessary to assure the authorization is communicated to the correct dispensing pharmacy or other entity. Many pharmacies have the same name, so additional information is always required. Print Form. Drug Prior Authorization Request Form. Fax: 877-243-6930.

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On this page, you will find a fillable PDF version of this form which you can download, as well as the fax number that you must send it to. Prior Authorization Form. Fax to: 1 (877) 243-6930. Phone: 1 (800) 285-9426. Part D Prior Authorization Form (Medicare) Part D Fax to: 1 (800) 693-6703.Born: July 31, 1958 · Pittsburgh, Pennsylvania, U.S. Education: University of Pittsburgh · Indiana University Bloomington ( BS) Occupation(s): Businessman, film ...2 web ashp s handbook on injectable drugs r is now newly updated with the latest information the 20th edition features 27 new monographs 23 663 compatibility pairs ...

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