DIRECT MEMBER REIMBURSEMENT DIRECTION FORM Thank you for participating in the Catalyst Rx prescription benefit program. If you are requesting reimbursement on a prescription claim, please take a moment to read the follow - Moment form - Document - PDFSEARCH.IO

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	DIRECT MEMBER REIMBURSEMENT DIRECTION FORM Thank you for participating in the Catalyst Rx prescription benefit program. If you are requesting reimbursement on a prescription claim, please take a moment to read the follow Add to Reading List Document Date: 2011-07-19 17:22:47 Open Document File Size: 70,84 KB Share Result on Facebook City Rockville / / Facility Pharmacy Phone Number / / / Person Reimbursement / / / Position pharmacist / Pharmacy NABP/NPI Fill Date Drug Name NDC Number Physician DEA/NPI Quantity Days Supply Amount Paid PHARMACIST / / ProvinceOrState Maryland / / SocialTag Health Clinical pharmacology Medical prescription Patient safety Prescription medication Pharmacist Pharmacy Pharmacology Medicine Pharmaceutical sciences

DIRECT MEMBER REIMBURSEMENT DIRECTION FORM Thank you for participating in the Catalyst Rx prescription benefit program. If you are requesting reimbursement on a prescription claim, please take a moment to read the followAdd to Reading List