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Large Group Forms and Resources

Related Files
Pharmacy Policies - General
» Preferred Drug List with Value Generics (Effective October 2014)
» Quote Request Form (2014)
Legal Documents
» Viva Health Custom Drug List (Effective April 2016)
» Notice of Health Information Practices (Updated Document September 2014)
Pharmacy Forms - Commercial
» Specialty Drugs Require Prior Auth – Commercial (Effective January 2012 - All unclassified drug codes (such as J3490, J3590, J8999 and J9999) require prior authorization. When requesting authorization for an unclassified drug please submit the NDC#, Drug Name, and Dosage.)