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MEDICATION PRIOR AUTHORIZATION REQUEST FORM Peach State Health Plan, Georgia (Do Not Use This Form for Biopharmaceutical Products*) FAX this completed form to 8663990929 OR Mail requests to: US Script

How to fill out 866 399 0929 form

Instructions on how to fill out 866 399 0929:

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3. In the following section, titled "Address," enter your complete mailing address, including the street name, house/apartment number, city, state, and zip code. Double-check for any misspellings or errors.
4. Proceed to the "Email Address" field and enter your preferred email address. Be cautious while typing to avoid any mistakes, as this will be used for communication purposes.
5. If applicable, navigate to the "Company/Organization" section and write the name of the company or organization you represent or are associated with. If not relevant, you can leave this field blank.
6. Lastly, review all the information you have filled out to ensure accuracy. Verify that every detail is correct before submitting the form.

Who needs 866 399 0929:

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