Prior Authorization Information Request for Injectable Drugs
Use this form for chemotherapy, HCPCS J-code requests and other IV medication requests administered by the physician/hospital.
Nias daim duab nram qab no los qhib daim ntawv PDF:
Contact Pharmacy Department
Tus Xov Tooj: 831-430-5507
Tus Xov Tooj Xa Ntawv (Fax): 831-430-5851
Hnub Monday-hnub Friday, 8 a.m. txog 5 p.m.
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