dsb-0511-instructions: DSB/Pharmacy Claim Form Instructions

Used by pharmacies that have signed a working agreement (DSB-4020: Pharmacy Agreement) with the Division of Services for the Blind (DSB) to provide pharmaceutical services to eligible individuals of the agency. These drugs include those authorized for diagnostic, palliative, or therapeutic purposes
Form Numberdsb-0511-instructions
Agency/DivisionServices for the Blind (DSB)
Form Effective Date 2015-06-07T15:25:00-04:00
Form File dsb-0511-instructions.pdf