Statement for Compound Prescription

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Title Statement for Compound Prescription
Description

Bill form for use by pharmacies and home infusion companies to submit compound drug charges. This form is for drug charges only and is filled out by the pharmacist.

Document number F245-010-000
How to get this document
Keywords drugs, pharmacist, pharmacy, prescriptions, reimbursement, self-insurance, self-insurer
Alt Language(s)
Valid dates 02/2014
Contact information Claims for Job Injuries, Employer Services
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