Pharmacy Prior Authorization Forms

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Pharmacy Prior Authorization Contact Information

 

Pharmacy Benefit Drugs (MedImpact):

Phone : (800) 210-7628

Prior Authorization Call Center: (844) 336-2676

Drug PA Fax : (858) 357-2612

 

Physician Administered Drugs (Passport):

Phone: (800) 578-0775

PAD PA Fax: (844) 802-1406