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MIDAS 30DAY MEDICATION REQUEST Michigan Department of Health and Human Services Michigan Drug Assistance Program (MIDAS)Mail or fax completed application and all supporting documentation to:MDHHSMIDAP109
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What is MIDAP 30-DAY MEDICATION REQUEST Form?

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Midap 30-day medication request is a form that allows patients to request a 30-day supply of medication.
Patients who need to refill their medication and meet certain eligibility criteria are required to file a midap 30-day medication request.
To fill out a midap 30-day medication request, patients need to provide their personal information, prescription details, and reason for the request.
The purpose of midap 30-day medication request is to ensure that patients have access to their medication when needed.
The information that must be reported on a midap 30-day medication request includes patient's name, prescription details, healthcare provider information, and reason for request.
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