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Prior Authorization Form Fax completed form to 1-800-357-9577

Prior Authorization Form Fax completed form to 1-800-357-9577
08.22.2011 Additional forms available: Prescriber Phone #: _____ Patient Phone #: Quantity Other Medications/Therapies tried and reason(s) for f

http://www.expressscripts.com/services/physicians/pa/docs/Humira_PA.pdf

Filesize: 5038.1 KB | Ebook format : .PDF


Prior Authorization Form Fax completed form to 1-800-357-9577
Prior Authorization Request Please fax completed form and Prescription to Express Scripts at 1-800-357-9577

http://www.express-scripts.com/services/physicians/pa/docs/Cialis_PA.pdf

Filesize: 5058.1 KB | Ebook format : .PDF


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