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The following products are covered and do not require PA cortisone hydrocortisone and . Send completed form to Service Benefit Plan Prior Approval P. O. Box 52080 MC 139 Phoenix AZ 85072-2080 Attn. Clinical Services Fax 1-877-378-4727 CARDHOLDER AND PATIENT INFORMATION Cardholder Name / / First MI Last Patient Name / / Patient Address Street / City / State / Zip Patient Date of Birth / / Sex M F R Cardholder Identification Number PHYSICIAN COMPLETES Rayos Please note The Service Benefit Plan...
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877 378 4727 is the phone number for the Internal Revenue Service (IRS) in the United States for reporting tax-related issues.
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