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(for Maryland Only) Prior Authorization Request Send completed form to: Case Review Unit, CVS Earmark Prior Authorization Fax: 18662496155 CVS Earmark administers the prescription benefit plan for

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For Maryland only refers to specific forms or documents that are intended to be filed only with the state of Maryland.

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Individuals or businesses who have income or activities in Maryland may be required to file for Maryland only.

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The information that must be reported on for Maryland only may include income earned in Maryland, business activities conducted in Maryland, or other relevant information specified by the state.

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