PDF
Word
Form F-00250 Request for Review of Member Prescription Drug Use - Pharmacy Services Lock-In Program - Wisconsin
What Is Form F-00250?
This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form F-00250?
A: Form F-00250 is a request form used for reviewing member prescription drug use in the Pharmacy Services Lock-In Program in Wisconsin.
Q: What is the Pharmacy Services Lock-In Program in Wisconsin?
A: The Pharmacy Services Lock-In Program in Wisconsin is a program that limits members to a specific pharmacy or prescriber in order to control their prescription drug use.
Q: Who uses Form F-00250?
A: Form F-00250 is used by members who wish to request a review of their prescription drug use in the Pharmacy Services Lock-In Program in Wisconsin.
Q: What can I request a review for?
A: You can request a review for your prescription drug use in the Pharmacy Services Lock-In Program in Wisconsin.
Q: How do I submit Form F-00250?
A: You can submit Form F-00250 by completing the form and sending it to the appropriate address listed on the form.
Form Details:
- Released on May 1, 2015;
- 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-00250 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.
