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Anthem Prescription Management, LLC Request for Electronic Media (CPDP 835) Date of Request: Pharmacy Name: NABP/ CPDP: Contact Name: Phone #: Is your pharmacy currently set up for direct deposit?

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What is electronic media independent request?

The electronic media independent request is a formal request made electronically to the relevant authority for specific media services without the need for physical presence or traditional paper-based applications.

Who is required to file electronic media independent request?

Any individual or organization seeking to avail media services through electronic means is required to file an electronic media independent request.

How to fill out electronic media independent request?

To fill out an electronic media independent request, one needs to access the designated online platform or portal provided by the authority and follow the instructions provided. The request form should be completed by providing all necessary information accurately.

What is the purpose of electronic media independent request?

The purpose of the electronic media independent request is to streamline the process of applying for media services, eliminating the need for physical paperwork and enabling efficient processing of requests through digital means.

What information must be reported on electronic media independent request?

The information required to be reported on an electronic media independent request may include details such as the applicant's name, contact information, media service type, desired duration, content description, and any other pertinent information as specified by the authority.

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