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Form F-00401 Preferred Drug List (Pdl) Expedited Emergency Supply Request - Wisconsin
What Is Form F-00401?
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-00401?
A: Form F-00401 is the Preferred Drug List (PDL) Expedited Emergency Supply Request form.
Q: What is the purpose of Form F-00401?
A: The purpose of Form F-00401 is to request an expedited emergency supply of a preferred drug from the Preferred Drug List (PDL) in Wisconsin.
Q: Who can use Form F-00401?
A: Form F-00401 can be used by Wisconsin residents who are enrolled in a Medicaid health plan or a BadgerCare Plus plan.
Q: What is the Preferred Drug List (PDL)?
A: The Preferred Drug List (PDL) is a list of medications that are covered by Medicaid and BadgerCare Plus plans in Wisconsin.
Q: What is an expedited emergency supply?
A: An expedited emergency supply is a temporary supply of medication that is provided when there is an immediate need for medication due to an emergency situation.
Q: How can I obtain Form F-00401?
A: Form F-00401 can be obtained from your Medicaid health plan or by contacting the Wisconsin Department of Health Services.
Q: What information do I need to provide on Form F-00401?
A: You will need to provide your personal information, information about the medication, and the reason for the emergency supply request on Form F-00401.
Form Details:
- Released on January 1, 2021;
- 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-00401 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.
Download Form F-00401 Preferred Drug List (Pdl) Expedited Emergency Supply Request - Wisconsin
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