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Publications, Notices, and Standing Orders for Pharmacy Providers

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Billing Forms

Open PDF file, 45.46 KB,  90-Day Waiver Form (English, PDF 45.46 KB)
Open TXT file, 3.73 KB,  90-Day Waiver Form (English, TXT 3.73 KB)
Prior Authorization Forms 

Copay Poster

Open PDF file, 178.93 KB,  Copayment Poster (English, PDF 178.93 KB)
Open DOCX file, 32.72 KB,  Copayment Poster (English, DOCX 32.72 KB)

POPS Information

Open PDF file, 1.87 MB,  POPS Billing Guide (English, PDF 1.87 MB)
Open DOCX file, 607.97 KB,  POPS Billing Guide (English, DOCX 607.97 KB)

Standing Orders

Open PDF file, 208.84 KB,  Oral Contraceptive Standing Order (English, PDF 208.84 KB)
Open DOCX file, 218.48 KB,  Oral Contraceptive Standing Order (English, DOCX 218.48 KB)
Open PDF file, 186.34 KB,  Prenatal Vitamin Standing Order (English, PDF 186.34 KB)
Open DOCX file, 182.07 KB,  Prenatal Vitamin Standing Order (English, DOCX 182.07 KB)

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