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The National IAM Benefit Trust Fund partnership with PrudentRx makes it possible to receive your covered specialty medications at $0 out of pocket cost when you fill your prescription at a CVS Specialty Pharmacy or other participating specialty pharmacies. For additional information about the PrudentRx Copay Program, please contact PrudentRx ... specialty drug: mbr call 866-387-2573 product/service not appropriate for this location drug requires prior authorization . created date: 3/2/2020 9:55:42 am ... 3569 Business Center Dr, Suite 175 Pearland, TX 77584 Phone: (888) 489-0038 Fax: (877) 674-0389 08/08/2023 PA Approved - Transferred Prescriber: Adaeze Egesi Patient: Jared Tarver

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866-387-0484. Claims. If you have a Short Term Medical, Dental, or National General Foundation Health plan, please call the number on the back of your IDcard. If you have a different plan, please follow the instructions on the claim submission forms. You can find them online located under Claim Forms tab. You can also contact customer service ...

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1 of 8 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2024– 12/31/2024 NMPSIA: Low Option Plan (BCBS of NM Network) Coverage for: Individual + Family | Plan Type: PPO. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan.Specialty Pharmacy at 1-866-387-2573. For most specialty drugs, the contracted specialty drug mail-order pharmacy is required. • These drugs must be filled via the CVS Specialty Pharmacy. Call 1-866-387-2573. • Specialty drugs that are essential health benefits and obtained from in-network retail and mail order locationsFor additional information about the PrudentRx Copay Program, please contact PrudentRx directly at 1 (800) 578-4403, Monday through Friday between 8 a.m. and 8 p.m., EST., to speak with a PrudentRx Member Advocate (English, Spanish, and additional language lines available). To view PrudentRx FAQs click here. CVS Specialty Pharmacy may be reached at 1-866-387-2573 and PrudentRx at 1-800-578-4403. Advanced Utilization Management Program. These programs may require additional information from a prescribing physician in order for a prescription to be covered and paid for by the University’s health plan. SPECIALTY DRUG: MBR CALL 866-387-2573 Addl bonal Messages SPECIALTY DRUG: MBR CALL 866-387-2573 DRUG REQUIRES PRIOR AUTHORIZATION LOCATION Limited PCN PERSON Phone Field Active Limited Ter NPI: 1033194287 P. (281)444-1288, F: (281)444-9177 Description t plan DEA Address- 819 PEAKWOOD Sec Insurance In …

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Caremark. Specialty Pharmacy Services, Information and Forms. CVS Caremark is dedicated to helping physicians manage and help their patients who are suffering from … o Members or their providers may call 1-866-387-2573 to submit a prescription to CVS Specialty Pharmacy o CVS Specialty can deliver medications to location of the members choice: • Home • Work • Pharmacy o CVS Specialty Pharmacy Care Team is available for members with questions such as order status, billing questions and medication side ... 1 of 8 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2024 – 12/31/2024 NMPSIA: BluePreferred EPO Plan (BCBS of NM Exclusive Network) Coverage for: Individual + Family | Plan Type: EPO. The Summary of Benefits and Coverage (SBC) document will help you choose a health …New York State residents may call the CSP toll-free referral line, 1-866-442-CANCER (2262), 24 hours a day, seven days a week, to be connected to the CSP in their area. Questions? Contact the Division of Program Development and Management at …Specialty drugs musts be dispensed by an Caremark specialty pharmacy (1-866-387-2573). ALWAYS PRESENT YOUR CAREMARK PRESCRIPTION DRUG CARD TO THE PARTICIPATING RETAIL PHARMACY. To locate a participates our go to www.caremark.com or call 1-800-824-6349. Caremark Subscription Process.Specialty Pharmacy at 1-866-387-2573. For most specialty drugs, the contracted specialty drug mail-order pharmacy is required. • These drugs must be filled via the CVS Specialty Pharmacy. Call 1-866-387-2573. • Specialty drugs that are essential health benefits and obtained from in-network retail and mail order locations Specialty Pharmacy at 1-866-387-2573. For most specialty drugs, the contracted specialty drug mail-order . pharmacy is required. • These drugs must be filled via the CVS Specialty Pharmacy. Call 1- 866-387-2573. • Specialty drugs that are essential health benefits and obtained from in-network retail and mail order locations We would like to show you a description here but the site won’t allow us.10970 Shadow Creek Pkwy, Suite 110.1 Pearland, TX 77584 Phone: (832) 284-4933 Fax: (888) 383-2140 08/15/2019 PA Approved

Pharmacy. Call 1- 866-387-2573. • Specialty drugs that are essential health benefits and obtained from in-network retail and mail order locations acc umulate to the Outpatient Drug Out-of-Pocket Limit noted on page 1. • Certain specialty drugs are filled through the PrudentRx program and exclusively dispensed by CVS Specialty Pharmacy.

For new prescriptions, your doctor can send a request via fax 1-866-329-2779 or may place a call to a registered pharmacist at 1-866-782-2779. The prescription may also be filled by completing a Patient Profile Form. Existing prescriptions may be filled by calling 1-866-387-2573. DELTA DENTAL (Dental)

Specialty Pharmacy at 1-866-387-2573. For most specialty drugs, the contracted specialty drug mail-order pharmacy is required. • These drugs must be filled via the CVS Specialty Pharmacy. Call 1-866-387-2573. • Specialty drugs that are essential health benefits and obtained from in-network retail and mail order locationsTo obtain a prior authorization, providers may contact CVS Caremark at 866-387-2573. Provider-administered (medical benefit) Covered under the medical benefit and subject to office charges. Medications are usually administered by intramuscular injection or intravenous injection or infusion.10970 Shadow Creek Pkwy, Suite 110.1 Pearland, TX 77584 Phone: (832) 284-4933 Fax: (888) 383-2140 02/17/2022 PA Approved Prescriber: An Nguyen Patient: Debbie Safford DOB: 05/09/1970 Medication: Xolair Prior authorization has been approved, however, due to plan setup, the patientSPECIALTY DRUG: MBR CALL 866-387-2573 PRODUCT,'SERVICE NOT APPROPRIATE FOR THIS Total: Pa bent Pay Amount: Other Amoœlts Accumulated Deduct& : Remainõg Deductible : Benefits Remaining : Amount Applied to Periocfc Deductible: Copay/Co-Insurance: 3,732. 11 0.00 INJECT 600 MG (Two 300 MG SYRINGES) UNDER THE …Specialty medications including growth hormones and those that treat the following conditions are not available for in-store pickup: HIV, infertility and transplant. Specialty medication is dispensed by CVS Caremark Specialty Pharmacy and shipped to CVS/pharmacy locations for in-store pickup. Send your specialty pharmacy scripts directly to CVS ...1-866-387-2573 Letters will be mail March 1, 2019 to impacted members and providers. Phone calls to impacted members to assist with the transfer process to a new Specialty Pharmacy will begin March 4, 2019. As providers, please note that your patient or the Specialty Pharmacy may be contacting you for a new prescription. We10970 Shadow Creek Pkwy, Suite 110.1 Pearland, TX 77584 Phone: (832) 284-4933 Fax: (888) 383-2140 07/20/2022 PA Approved Prescriber: William Yao Patient: Senyo Atisogbuie DOB: 05/16/1975 Medication: Dupixent Prior authorization has been approved, however, due to plan setup, the patientTransferred to Pharmacy: CVS Specialty (866) 387-2573 Patient has been notified. We have left voicemail for the patient. Thank you for your referral. Please do not hesitate to call us with any questions. Author: Tran Nguyen Created Date:

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