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Form 872 Birmingham Alabama: What You Should Know
Please fax Commercial Coverage Determination form(s) to Viva Health at for other drug(s) that will be filled based on the medical claims. FURNISHING Please fax Commercial Coverage Determination form(s) to Viva Health at for other drug(s) that will be filled at an approved medical distribution center (MDC) with a Pharmacy License from a state other than Alabama, Kentucky, Mississippi, Oklahoma, South Dakota and Wyoming. The pharmacist filling the form should have the current pharmacy license information on file. PHARMACY Please telephone the Viva Health Sales Desk to ask if any of our pharmacies has purchased a CARD for Drug Delivery. To ensure availability and service in your area, a Viva Health CDL will be installed for your pharmacy. To order an eligible drug for VDD, please telephone to obtain the CARD for the drug(s) requested. Pharmacies ordering drugs will fill a VDD for the same Drug(s) that would have been filled and delivered to the pharmacy for your order if not for the CARD requirement. If you are a small company wishing to purchase multiple drugs for distribution, please phone to talk with our sales staff and determine what delivery options are available based on your needs. PHARMACY This form will help us to determine if your drug is covered by the Federal Insurance Contribution Act (FICA). This form will help us to determine if your employer has provided health insurance or paid employees' medical expenses. This is the final, authoritative form that is used to determine a patient's drug coverage under Medicaid, Medicare, and certain Federal Employee Health Benefits (FEB) programs. Please complete this form as accurately as possible. It serves no function to simply fill out a form. Please note that all the information contained on this form is confidential and will not be shared with anyone other than with the IRS. This form is designed to be reviewed by a third party and will not be reviewed by us or with the customer at any time. It is your responsibility, and we cannot guarantee the completeness of this form. This is for the IRS. If there are questions related to form 990-INT or 990-EZ, please visit IRS.gov/Form990 for additional guidance. Do not use forms 831 or 832.
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