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1-877-342-4596 Call 1-877-445-6874 Ready to prescribe? Just e-prescribe, fax or call in your patient’s prescription to Optum® Specialty Pharmacy. We’ll handle the rest. Once we receive the prescription, we will: • Complete a benefits investigation and prior authorization • Aid patients in obtaining financial assistance programsOptum Specialty Phone: 877-445-6874 | Optum Specialty Fax: 877-342-4596 Please detach before submitting to a pharmacy – tear here PATIENT INFORMATION PRESCRIBER INFORMATION Please complete the following or send patient demographic sheet Prescriber’s Name Patient Name DEA/NPI Address Group / Hospital City, State, ZIP Address Onco360 www.onco360.com 1-877-662-6633 1-877-662-6355 Monday to Friday 7 am to 7 pm EST Saturday 9 am to 5 pm EST 24/7 on-call service Optum Specialty Pharmacy www.optum.com 1-877-445-6874 1-877-342-4596 Monday to Friday 5 am to 7 pm PST Saturday 6 am to 5 pm PST Call our dedicated oncology team at 1-877-445-6874. American Cancer Society Phone: 1-800-227-2345 cancer.org ; National Cancer Institute Phone: 1-800-422-6237 cancer.gov ; National Comprehensive Cancer Network

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The information found on NPIdb.org is provided "AS IS" and in accordance with the NPPES Data Dissemination Notice, Freedom of Information Act (FOIA) and e-FOIA ammendments.The NPI Enumerator can be reached at (800) 465-3203 or P.O. Box 6059, Fargo, ND 58108

Phone: 877-445-6874; Fax: 877-342-4596; Hours of operation: Monday-Friday, 8 am-10 pm (EST) Saturday, 8 ...

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Optum Specialty Phone: 877-445-6874 | Optum Specialty Fax: 877-342-4596 Please detach before submitting to a pharmacy – tear here PATIENT INFORMATION PRESCRIBER INFORMATION Please complete the following or send patient demographic sheet Prescriber’s Name Patient Name DEA/NPI Address Group / Hospital City, State, …

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1-877-342-4596 Call 1-877-445-6874 Ready to prescribe? Just e-prescribe, fax or call in your patient’s prescription to Optum® Specialty Pharmacy. We’ll handle the rest. Once we receive the prescription, we will: • Complete a benefits investigation and prior authorization • Aid patients in obtaining financial assistance programs

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