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 Number | dsb-0511-instructions |
Agency/Division | Services for the Blind (DSB) |
Form Effective Date | 2015-06-07T15:25:00-04:00 |
Form File | dsb-0511-instructions.pdf |