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1/2AUTHORIZATION FAX TO (516) 3945684 for Specialty Drugs REQUEST501 Franklin Avenue, Suite 300 Garden City, New York 11530 Phone: (516) 7462200 (888) 7462200Date: ___or (516) 5158806 for Oncology
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The 2134 pharmacy-auth-request-form-20212 is a specific form used for requesting authorization for pharmacy services and medications, typically required by healthcare providers or pharmacies to obtain approval from insurance companies or governmental agencies.
Healthcare providers, pharmacies, and patients who seek authorization for certain medications or pharmacy services that require prior approval are required to file the 2134 pharmacy-auth-request-form-20212.
To fill out the 2134 pharmacy-auth-request-form-20212, you need to provide accurate patient information, details regarding the requested medication or service, justification for the request, and any supporting documentation required by the payer.
The purpose of the 2134 pharmacy-auth-request-form-20212 is to formally request prior authorization from insurance providers or regulatory bodies for specific medication or pharmacy services to ensure coverage and payment.
Information required on the 2134 pharmacy-auth-request-form-20212 typically includes patient identifiers, medication details, dosage, prescribing physician information, and justification for the requested authorization.
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