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AmeriHealth Capital Iowa Request for Prior Authorization Modified FormulationsForm applies to IA Health Link and Hawks plans. Please print accuracy is important. Fax completed form to 18558252714.
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Copy and paste the original formulations into the new document.
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Modified formulations - prior refer to any changes made to previously submitted formulations before the deadline.
Any entity or individual who has made changes to their previously submitted formulations is required to file modified formulations - prior.
To fill out modified formulations - prior, the individual or entity must provide details of the changes made to the previously submitted formulations and submit it before the deadline.
The purpose of modified formulations - prior is to ensure that any changes made to the previously submitted formulations are documented and reviewed by the relevant authorities.
The information that must be reported on modified formulations - prior includes details of the changes made, reasons for the changes, and any supporting documentation.
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