CONTAINS CONFIDENTIAL PATIENT INFORMATION and Depot Complete form in its entirety and fax to: Empire Pharmacy Management (EPM) at (845)6953191 or (845)6953804 Or Mail to: Prior Approval Department Box 5099, Middletown, NY-2026

Microsoft Word doesn’t have signing tools to create valid electronic signatures and enforceable forms. Luckily, DocHub is an online eSignature-compliant editor that supports different file formats, including .doc files. Sign in to your account and upload the Word edition of your CONTAINS CONFIDENTIAL PATIENT INFORMATION and Depot Complete form in its entirety and fax to: Empire Pharmacy Management (EPM) at (845)6953191 or (845)6953804 Or Mail to: Prior Approval Department Box 5099, Middletown, NY from your device and cloud, or URL - our editor will automatically turn it into an editable PDF. Make all essential alterations in your document and click Sign to create your own legally-binding eSignature. There are four signing options from which to choose.

If you are searching for a state-specific CONTAINS CONFIDENTIAL PATIENT INFORMATION and Depot Complete form in its entirety and fax to: Empire Pharmacy Management (EPM) at (845)6953191 or (845)6953804 Or Mail to: Prior Approval Department Box 5099, Middletown, NY sample, you will find it in our DocHub Forms & Templates catalog. Use the search field, key in your form’s name, and search through the results for your state. You may also filter out irrelevant results while browsing our catalog by groups.