Pharmacy Provider Information:
Pharmacy providers should use this form after receiving a claims rejection code stating "NDC PRICE MISSING, CALL MYERS & STAUFFER". Please do not include any personal health information (PHI) with submitted form or invoice.
You must fax to (317) 571-8481 (Attention: Pharmacy Unit) or email firstname.lastname@example.org copies of your purchase records that confirms your acquisition costs information.
Once complete information is received, we will evaluate your inquiry and respond within 24 hours. For questions or to check the status of an inquiry, please contact us by email at email@example.com or by phone at 800-591-1183.