Prior Authorization/Preferred Drug List (PA/PDL) for Expedited Emergency Supply Request

Assigned Number	Title	Version Date	Publication Type	Other Location	Language
F-00401	Prior Authorization/Preferred Drug List (PA/PDL) for Expedited Emergency Supply Request	January 1, 2020	PDF	None	English
F-00401	Prior Authorization/Preferred Drug List (PA/PDL) for Expedited Emergency Supply Request	January 1, 2020	Word	None	English
F-00401	Prior Authorization/Preferred Drug List (PA/PDL) for Expedited Emergency Supply Request Instructions	January 1, 2020	PDF	None	English

Last Revised: January 7, 2020