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Get And Sign Universal Pharmacy Oral Prior Authorization Form

Additional information which may be relevant to the review of this prior authorization request Please return this form to PerformRx AmeriHealth Caritas Pennsylvania 200 Stevens Drive Philadelphia PA 19113 Or FAX to 1-215-937-5018 ACPA19729874-7 Date. UNIVERSAL PHARMACY ORAL PRIOR AUTHORIZATION FORM form effective 7/21/20 Fax to PerformRx at 1-888-981-5202 or to speak to a representative call 1-866-610-2774....

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