Multi-Ingredient Compound Drug Prior Authorization Request Form

Department of Community Health

This government document is issued by Department of Community Health for use in Georgia

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https://www.google.com/url?client=internal-element-cse&cx=450907bf5042c4844&q=https://dch.georgia.gov/document/document/compound-pa-request-form/download&sa=U&ved=2ahUKEwi_lJiazZaHAxWZhv0HHXUsA5A4KBAWegQIAhAB&usg=AOvVaw25_wUGB7CxYnrbcShz_Juz&fexp=72519171,72519168

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