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UNIFORM PHARMACY PRIOR AUTHORIZATION REQUEST FORM CONTAINS CONFIDENTIAL PATIENT INFORMATION Complete this form in its entirety and send to Rocky Mountain Health Plans at 8337879448Urgent 1 Monument
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Ubrelvytm is typically prescribed for individuals who suffer from migraines.
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Ubrelvytm is a medication used to treat migraines in adults.
The manufacturer or marketing authorization holder of Ubrelvytm is required to file.
The filing can be done electronically through the appropriate regulatory authorities.
The purpose of Ubrelvytm is to provide relief from migraine symptoms.
Information such as safety data, efficacy studies, manufacturing information, and labeling details must be reported.
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