Provider Forms and Resources - ALL

Abortion Consent Form

Hysterectomy Consent Form

Pregnancy Notification Form (PNF)

Prior Authorization Form

Provider Administration Manual (PAM) - KS

Provider Quick Guide (KS)

Sterilization Consent Form (KS)

Specialty Pharmacy Form

Urgent Care Locations

Urgent Care Locations - Wichita

Pharmacy forms (KS)

Preferred Drug List (updated 10-01-2012)

Specialty Drug List and Approval Process (see page 2)

Pharmacy Reimbursement Form (Caremark Paper Claim Form)

Pharmacy Reimbursement Override (Caremark Paper Claim Override)

Caremark Drug Coverage Check

Prenatal Vitamins formulary list

Medication Exception Request

Caremark Enrollment Form

Preferred Lancets and Lancet Devices

Specialty Pharmacy Form

Kansas: 1-877-347-9363 toll-free
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