Smoking Cessation Ther​apy Authorization form

Bureau for Medical Services

This government document is issued by Bureau for Medical Services for use in West Virginia

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File Details: PDF (50.9 KB)
Source
https://dhhr.wv.gov/bms/BMS%20Pharmacy/Documents/Pharmacy%20Forms/Tobacco%20Cessation%20PA%20FORM%2001_2022_v2.pdf

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