Webfrom Walgreens Specialty Pharmacy – Highmark’s exclusive specialty pharmacy vendor – for the injectable drugs listed above. However providers who wish to use telephone or fax to obtain prior authorization for these drugs must contact Walgreens Specialty Pharmacy . at one of the following prior authorization dedicated numbers: WebFor other helpful information, please visit the Highmark Web site at: www.highmark.com MM-060 (R9-05) Specialty Drug Request Form Once completed, please fax this form to1-866-240-8123. To view our formularies on-line, please visit our Web site at the addresses listed above. Please use a separate form for each drug.

SPECIALTY DRUG REQUEST FORM

WebCystic fibrosis prescription referrals may be sent to any of our locations as well as our dedicated cystic fibrosis pharmacy. If you are unsure where to send a prescription to, please call us at 855-244-2555. Address. E-prescribing Name. Canton, MI. 41460 Haggerty Circle South. Canton, MI 48188. Phone: 888-282-5166. Fax: 888-570-4700. WebSpecialty Drug Request Form picture_as_pdf DOWNLOAD PDF Vision Claims, mail order, … orange beach al drowning

Your Health Care Partner Highmark

WebHome ... Live Chat WebSPECIALTY DRUG REQUEST FORM Once completed, please fax this form to1-866-240-8123. To view our formularies on-line, please visit our Web site at the addresses listed above. Please use a separate form for each drug. Print, type or WRITE LEGIBLY and complete form in full. If approved, the payor will forward to the exclusive specialty vendor. Web1. Submit a separate form for each medication. 2. Complete ALL information on the form. NOTE: The prescribing physician (PCPor Specialist) should, in most cases, complete the form. 3. Please provide the physician address as it is required for physician notification. 4. Fax the completed form and all clinical documentation to 1-866-240-8123 orange beach al churches