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UNIFORM PHARMACY PRIOR AUTHORIZATION REQUEST FORM CONTAINS CONFIDENTIAL PATIENT INFORMATION Complete this form in its entirety and send to Rocky Mountain Health Plans at 8583572538 Urgent 1 Requested
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Fidaxomicin - rocky mountain is a type of antibiotic medication used to treat infections caused by certain bacteria.
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The purpose of fidaxomicin - rocky mountain is to accurately report information related to the use and distribution of the medication.
Information such as patient demographics, dosage, and duration of treatment must be reported on fidaxomicin - rocky mountain.
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