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December 31, 2022
New prescription physician fax form
Use this form to order a new mail service prescription by fax from the prescribing physician’s office.
September 30, 2022
Pharmacy Provider Relations Intake Form
Use this form to submit network rejections, pricing inquiries, and claim payment issues to Pharmacy Provider Relations.
May 14, 2018
Long term care pharmacy attestation form
Use this form to enter your attestation to the CMS requirement.
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