Form 369 Pharmacy Prior Authorization Request Form - Alabama

What Is Form 369?

This is a legal form that was released by the Alabama Medicaid Agency - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

• Released on June 1, 2023;
• The latest edition provided by the Alabama Medicaid Agency;
• Easy to use and ready to print;
• Quick to customize;
• Compatible with most PDF-viewing applications;
• Fill out the form in our online filing application.

Download a printable version of Form 369 by clicking the link below or browse more documents and templates provided by the Alabama Medicaid Agency.