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  • Wellcare Injectable Infusion Form

Get Wellcare Injectable Infusion Form

WELLCARE INJECTABLE INFUSION FORM Prior Authorization Request for WellCare of Florida Staywell and HealthEase FAX to 1-866-825-2884 WellCare Pharmacy - Injectable Infusion Department Requested by Physician Member Pharmacy Appointed Representative Complete each section legibly and completely include any additional Date necessary medical records or laboratory results Submitted Member ID Provider ID Name Address City State Zip Phone DOB Contact .

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  1. Access the document in the feature-rich online editor by clicking Get form.
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  1. Access the required template from the directory.
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Contact support

Wellcare Prescription Drug Plans: 1-866-859-9084 (TTY 711) Monday–Friday, 8 a.m. to 8 p.m.

Providers should submit Fee For Service claims to 'Ohana Health Plan Payer ID 14163. Providers can also use their own vendor/clearinghouse to submit electronically.

Fax: Complete an appeal of coverage determination request. and fax it to 1-866-388-1766. Mail: Complete an appeal of coverage determination request.

MAIL, EMAIL OR FAX ALL MEMBER GRIEVANCES TO: Wellcare Attn: Grievance Department P.O. Box 31384 Tampa, FL 33631-3384 Fax: 1-866-388-1769 Email: Please visit the Contact Us page on the website.

Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PFFS, PDP plan with a Medicare contract and is an approved Part D Sponsor. Our D-SNP plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232