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2018 Select Formulary - southernscripts.net
2018 Select Formulary Effective 07/01/2018 The Formulary List is a guide providing tier designation for common medicines within select therapeutic categories.
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DRUG NAME DRUG NAME - Southern Scripts, LLC
www.southernscripts.netSpecialty Drug List 3 *LDD-Limited distribution drug that must be filled at a specified pharmacy. ver10262017 DRUG NAME DRUG NAME Cytarabine SOLR Eligard KIT
FAX BACK TO 318-214-4190 EXPEDITED REVIEW …
www.southernscripts.net7/9/2014 Phone: 1-800-710-9341 PRIOR AUTHORIZATION FORM GENERAL FORM PROVIDER INFORMATION PATIENT INFORMATION Provider …
GENERAL INFORMATION TRANSACTIONS …
www.southernscripts.net2 Insurance Segment Claim Billing Field # NCPDP Field Name Value Payer Usage Payer Situation 306 -C6 PATIENT RELATIONSHIP CODE O
2018 National Formulary - Southern Scripts, LLC
www.southernscripts.net2018 National Formulary Effective 01/01/2018 The Formulary List is a guide providing tier designation for common medicines within select therapeutic categories.
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