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Office of Medical Assistance Programs FeeforService, Pharmacy Division Phone 18005378862 Fax 18663270191ONCOLOGY AGENTS, ORAL PRIOR AUTHORIZATION FORM Prior authorization guidelines for Oncology Agents,

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To fill out the www.dhs.pa.gov providers pharmacy-services/radicava-edaravone form, follow these steps: 1. Visit the website www.dhs.pa.gov.

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The wwwdhspagov providers pharmacy-servicesradicava edaravone is a reporting form for pharmacy services related to the drug Radicava (edaravone).

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Pharmacy providers who dispense Radicava (edaravone) are required to file the wwwdhspagov providers pharmacy-servicesradicava edaravone form.

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Pharmacy providers can fill out the wwwdhspagov providers pharmacy-servicesradicava edaravone form online or submit a physical copy via mail.

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The purpose of wwwdhspagov providers pharmacy-servicesradicava edaravone is to report pharmacy services related to the drug Radicava (edaravone) for regulatory and monitoring purposes.

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Pharmacy providers must report information such as the quantity of Radicava dispensed, patient information, prescribing physician, and dispensing pharmacy details.

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