Easy-to-Read fill-in-the-blank form that enables pharmacy to explain reason for not filling a prescription - Effective 9/1/13

Medicaid Agency

This government document is issued by Medicaid Agency for use in Alabama

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File Details: PDF (251 KB)
Downloads: 22
Source
https://medicaid.alabama.gov/documents/9.0_Resources/9.4_Forms_Library/9.4.13_Pharmacy_Services/9.4.13_PH_Recipient_Denial_Form_Revised_9-1-13.pdf

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