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Get Ambetter Prior Authorization Request Form For Prescription Drugs 2019-2025
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Express Scripts is the TPHARM contractor for DoD. • The provider may call: 1-866-684-4488. or the completed form may be faxed to: 1-866-684-4477. to the prescription and mail it to: Express Scripts, P.O. Box 52150, Phoenix, AZ 85072-9954. or email the form only to: TPharmPA@express-scripts.com.
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