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Form F-00030 State and Specialty Maximum Allowed Cost Drug Pricing Review Request - Wisconsin
What Is Form F-00030?
This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. Check the official instructions before completing and submitting the form.
FAQ
Q: What is Form F-00030?
A: Form F-00030 is a State and Specialty Maximum Allowed Cost Drug PricingReview Request specifically for Wisconsin.
Q: What is the purpose of Form F-00030?
A: The purpose of Form F-00030 is to request a review of maximum allowed cost pricing for drugs in Wisconsin.
Q: Who can use Form F-00030?
A: Form F-00030 can be used by individuals or entities in Wisconsin who want to request a review of maximum allowed cost pricing for drugs.
Q: What is maximum allowed cost pricing?
A: Maximum allowed cost pricing is the maximum amount that a payer will reimburse for a particular drug.
Q: How do I complete Form F-00030?
A: To complete Form F-00030, you will need to provide information about the drug, the prescribing physician, and the reason for the review request.
Form Details:
- Released on April 1, 2017;
- The latest edition provided by the Wisconsin Department of Health Services;
- 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 fillable version of Form F-00030 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.
Download Form F-00030 State and Specialty Maximum Allowed Cost Drug Pricing Review Request - Wisconsin
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