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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.
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;
- Fill out the form in our online filing application.
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.
