Grand Valley Health Plan | Provider Directory | GVHP Enbrel Humira Raptiva Kineret Form

Home > Providers > Forms > GVHP Enbrel Humira Raptiva Kineret Form

GVHP Enbrel Humira Raptiva Kineret Form

Size: 106Kb

This form is for preauthorization of the specialty drugs Enbrel, Humira, Raptiva, and Kineret.

These specialty drugs must be filled by Diplomat Pharmacy for GVHP patients.

Download this file

The above file is in Adobe PDF format. If you do not have Acrobat Reader, you will not be able to view or print this file. To download Acrobat Reader free, click here.