Get the free FAX this form to: State of Louisiana Form: Rx PA02...

FAX this form to: La Medicaid Rx PA Operations ULM College of Pharmacy FAX 866-797-2329 PHONE 866-730-4357 State of Louisiana Department of Health and Hospitals Bureau of Health Services Financing

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3. If the form requires any additional information, such as a reference number or account details, make sure to include them accurately.
4. Read each section of the form carefully and fill in the required information accordingly. Pay attention to any special instructions or guidelines provided.
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6. Once you have completed filling out the form, gather any necessary supporting documents or attachments that may be required. Make sure they are organized and attached securely.
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8. Dial the recipient's fax number or enter it into the online fax service. Double-check the number to avoid any potential errors.
9. Place the completed form and its attachments face down on the fax machine or upload them appropriately if using an online fax service.
10. Initiate the fax transmission by following the instructions provided by the fax machine or online service. Confirm that the transmission was successful and keep the transmission confirmation for your records.

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