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Prime Therapeutics LLC fax number
(877) 254-3794
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Authorization Form Processing
Used for: Release of information (PHI) to designated recipient; authorization for release of information
Fax destination details
- Department
- Authorization Form Processing
- Purpose
- Release of information (PHI) to designated recipient; authorization for release of information
- Form
- Authorization for Release of Information — Authorization for Release of Information
- Address
- P.O. Box 64812, St. Paul, MN 55164-0812
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Fill in the member’s name, ID number and date of birth; fill in the name, address and phone number of the recipient; indicate the purpose for the authorization; sign; mail or fax this form to Prime Therapeutics LLC, Attention: Authorization Form Processing, P.O. Box 64812, St. Paul, MN 55164-0812; Fax: 877.254.3794.
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