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UNIFORM PHARMACY PRIOR AUTHORIZATION REQUEST FORM CONTAINS CONFIDENTIAL PATIENT INFORMATION Complete this form in its entirety and send to Rocky Mountain Health Plans at 8583572538 Urgent 1 Monument
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What is requested drug name escallantide?
Escallantide is a drug used for....
Who is required to file requested drug name escallantide?
The manufacturer of the drug is required to file...
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To fill out the form for escallantide, one must...
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The purpose of reporting escallantide is to ensure...
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