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Get State Maximum Allowed Cost Drug Pricing Review Request - Dhs Wisconsin

DHEALTH STATE MAXIMUM ALLOWED COST DRUG PRICING REVIEW REQUEST Instructions: The use of this form is mandatory to request the review of state Maximum Allowed Cost (MAC) pricing in the ForwardHealth drug index. Pharmacists are required to submit documentation to substantiate their actual net cost and sign the certifying statement below. The pharmacy must submit an invoice having a product date of purchase within 60 days of submitting the request. Refer to the State Maximum Allowed Cost Drug Pric.

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