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State of Maine Department of Health & Human Services Maintain/MODEL Prior Authorization Form SEDATIVE / HYPNOTICS Phone: 18884450497www.mainecarepdl.organ: 18888796938Please use the Brand Name PA
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The brand is a symbol or name used to identify a company or product.
Companies or individuals who own the brand are required to file.
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The purpose of the brand is to create a unique identity and distinguish a company or product from others.
Information such as the name, logo, and description of the brand must be reported.
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