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HEALTH PARTNERS PLANS PRIOR AUTHORIZATION REQUEST Forman Agents Topical Phone: 2159914300Fax back to: 8662403712Health Partners Plans manages the pharmacy drug benefit for your patient. Certain requests
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What is is this a request?
This is a request for information or action.
Who is required to file is this a request?
The entity or individual specified in the request is required to file it.
How to fill out is this a request?
Fill out the form provided with accurate information requested.
What is the purpose of is this a request?
The purpose of the request is to gather specific information or request a particular action.
What information must be reported on is this a request?
The information requested on the form must be accurately reported.
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