Statement for Compound Prescription
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
||
| Title |
Statement for Compound Prescription (A fillable form - 277 KB PDF)
|
|
| 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. See the Pharmacy Billing Instructions (F248-021-000) for information on completing this form. | |
| Detail | ||
| Form number | F245-010-000 | |
| Availability | Order it |
|
| Keywords | drugs, pharmacist, pharmacy, prescriptions, reimbursement, self-insurance, self-insurer | |
| Languages | English | |
| Valid dates | 04-2010 | |
| Contact information |
Managing Injured Workers' Claims
Claims for Job Injuries |
|
| Related information | ||
| Documents | Statement for Pharmacy Services |
|
| Web pages | For Medical Providers | |
We value your feedback!
Please take this survey to help improve the L&I website.
Take survey
(About 3 minutes)
© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.