transparency
flexibility
results
expect more...

Services

AHCCCS Pharmacy & Therapeutics Committee Public Testimony Form

Pharmacy & Therapeutics Committee | Public Testimony Registration

  1. -
  2. (ex: username@domain.com)
  3. / - (ex: 800/555-1234)
  4. / -
  5. Mailing Address
    E-mail
    Facsimile
  6. Check here if you are representing or speaking on behalf of any company / organization.
  7. Check here if you are a private practice physician not affiliated with any manufacturer / organization.
  8. Please check the box of the statement that best applies.
  9. I do not have a current or recent (within the last 24 months) financial arrangement or affiliation with any organization that may have a direct interest in the business before the AHCCCS P&T Committee.
  10. I have a financial interest, affiliation or am employed by an organization that may have a direct interest in the business before the AHCCCS P&T Committee.
  11. OrganizationRole / Relationship
  1.  |  Clear Form

For questions about the PDL, please e-mail your questions to AHCCCSPharmacyDept@azahcccs.gov.

Back to the Arizona Medicaid page.