Statement for Compound Prescription

Statement for Compound Prescription - (Forms/Publications)
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Title Statement for Compound Prescription (A fillable form - 186 KB PDF)

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.

Form number F245-010-000
Online only. See document above to download.
Keywords drugs, pharmacist, pharmacy, prescriptions, reimbursement, self-insurance, self-insurer
Languages English
Valid dates 02-2014
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