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Send To: AcariaHealth Specialty Pharmacy Provider: Date: Date Medication Required: Ship to: Physician Patients Home Other Phone: (855) 5351815 Fax: (855) 8159894 Prior Authorization Form Patient Name:
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How to fill out 855 535 1815:

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Begin by entering the area code "855".
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Followed by the next three digits, "535".
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Finally, enter the last four digits, "1815".

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