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Blue Cross Complete Medication Prior Authorization Request Confidential Information Submit the completed form o By fax to 1-855-811-9326 By mail to PerformRx for Blue Cross Complete 200 Stevens Drive CC236 Philadelphia PA 19113 Note Blue Cross Complete s prior authorization criteria for a brand-name DAW request Documentation of an adverse event or lack of efficacy with the generic formulation and completion of an FDA MedWatch form. Please forwar.

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