This form is a business type form that is formatted to allow you to complete the form using Adobe Acrobat or Word. The word files have been formatted to allow completion by entry into fields. Some of the forms under this category are rather simple while others are more complex. The formatting is worth the small cost.
Oklahoma Fax Transmittal Form
Category:
State:
Multi-State
Control #:
US-141-AZ
Format:
Word;
PDF;
Rich Text
Instant download
Description
How to fill out Fax Transmittal Form?
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FAQ
Pharmacy PA Requests should be faxed to: OKC Metro (405)271-4014 or Toll-Free (800)224-4014.
PHARMACY REQUESTS Authorization Unit (MCAU), approves or disapproves each medication authorization request on behalf of the OHCA. The MCAU staff can be reached by phone at 405-522-6205 option 4 / 800-522-0114 option 4 or by fax at 405-271-4014 / 800-224-4014.
Soon-To-Be-Sooners (STBS) (effective: 4/1/2023) Size of HouseholdMonthly IncomeAnnual Income1$2,552$30,6242$3,453$41,4363$4,352$52,2244$5,250$63,0004 more rows ?
Essential Fax Cover Letter Elements are: Include your name and contact information. Include your fax number. State the purpose of the fax. Include the intended recipient's contact info. Date and time sent. Number of pages in the document.
Member or Applicant with questions about SoonerCare? For assistance with the Online SoonerCare Application or other questions or concerns about SoonerCare, please call the SoonerCare Helpline at 800-987-7767.
OTC Cough and Cold products now covered for children through SoonerCare! SoonerCare now covers selected non-prescription cough and cold products for children under 21 years of age.
