Prior Authorization Form (Optum Rx) for Ihs and 638 Tribal Facilities / Pharmacies - Arizona

Prior Authorization Form (Optum Rx) for Ihs and 638 Tribal Facilities / Pharmacies - Arizona

Prior Authorization Form (Optum Rx) for Ihs and 638 Tribal Facilities/Pharmacies is a legal document that was released by the Arizona Health Care Cost Containment System - a government authority operating within Arizona.

FAQ

Q: What is the Prior Authorization Form for Ihs and 638 Tribal Facilities/Pharmacies in Arizona?
A: It is a form used for obtaining approval from Optum Rx for medications that require prior authorization.

Q: Who can use the Prior Authorization Form?
A: Ihs and 638 Tribal Facilities/Pharmacies in Arizona can use it.

Q: What is the purpose of the form?
A: The form is used to request authorization for certain medications before they can be dispensed.

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Form Details:

  • The latest edition currently provided by the Arizona Health Care Cost Containment System;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Arizona Health Care Cost Containment System.

Download Prior Authorization Form (Optum Rx) for Ihs and 638 Tribal Facilities / Pharmacies - Arizona

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