Crime Victims Statement for Pharmacy Services

Crime Victims Statement for Pharmacy Services - (Forms/Publications)
Document Information
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Title Crime Victims Statement for Pharmacy Services (A fillable form - 122 KB PDF)
Description

Used by Crime Victims Compensation Program providers to bill for pharmacy services. Crime Victims Compensation Program providers are required to bill using this form.

Detail
Form number F800-058-000
Availability
Online only. See document above to download.
Keywords cvc, CVC, CVCP, drugs, medical billing, medical bills, pharmacist, pharmacy, prescriptions, reimbursement, victim
Languages English
Valid dates 09-2013
Contact information Crime Victims Compensation
Web pages Help for Crime Victims

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