Long term care pharmacy attestation form
Use this form to enter your attestation to the CMS requirement
LTC Pharmacy Attestation - Alternate Processing
Instructions:
- Pharmacy must review the attestation form
- Fill out the pdf form with your company name, NCPDP #, signature, name, title, and date
- For additional question contact Pharmacy Provider Relations at 877-633-4701 or email provider.relations@optum.com
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