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HEALTH PARTNERS PLANS PRIOR AUTHORIZATION REQUEST FORMFILGRASTIM AGENTS Phone: 2159914300Fax back to: 8662403712Health Partners Plans manages the pharmacy drug benefit for your patient. Certain requests

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What is how to request a?

A request on how to obtain certain information or services.

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Anyone who needs specific information or services.

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By following the instructions provided and providing necessary details.

What is the purpose of how to request a?

To formally ask for specific information or services.

What information must be reported on how to request a?

Details on the requested information or services.

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