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Maryland Medicaid Pharmacy
Program
Fax: (410) 3335398
Phone: (800) 4925231 Option 3Ingrezza Prior Authorization Form
Incomplete forms will not be reviewedDate: ___
Patient Information:
Name:DOB:MA#:Mex:Prescriber
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The test-healthmarylandgovmmcppapdhmhmaryland medicaid pharmacy program is needed by individuals who meet the eligibility criteria for Medicaid and require prescription medications. This program is specifically designed to provide affordable pharmacy services to eligible Maryland residents who are unable to afford the cost of medications on their own. Eligible individuals may include low-income individuals, pregnant women, children, elderly, and disabled individuals.
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What is test-healthmarylandgovmmcppapdhmhmaryland medicaid pharmacy program?
The Maryland Medicaid Pharmacy Program (MMPP) is a program that provides prescription drug coverage to eligible Medicaid beneficiaries in Maryland.
Who is required to file test-healthmarylandgovmmcppapdhmhmaryland medicaid pharmacy program?
Pharmacies and healthcare providers who participate in the Maryland Medicaid program are required to file the MMPP.
How to fill out test-healthmarylandgovmmcppapdhmhmaryland medicaid pharmacy program?
The MMPP can be filled out online through the Maryland Health Connection website or by contacting the Maryland Medicaid program directly.
What is the purpose of test-healthmarylandgovmmcppapdhmhmaryland medicaid pharmacy program?
The purpose of the MMPP is to ensure that Medicaid beneficiaries have access to necessary prescription medications at an affordable cost.
What information must be reported on test-healthmarylandgovmmcppapdhmhmaryland medicaid pharmacy program?
The MMPP requires reporting of prescription drug claims, beneficiary information, and pharmacy/provider information.
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