For other uses, see Dominic (disambiguation). Dominic is a name common among Roman Catholics and other Latin-Romans as a boys name. Originally from the late Roman-Italic name Dominicus its translation means Of Our Lord, Lordly, Belonging to God or of the Master.
ï· Call us at 1-888-693-3211. ï· Fax an eviCore healthcare request form (available online) to 1-888-693-3210. Also, to ease the administrative burden of requiring prior authorization of OB Ultrasound studies, providers may batch service requests for up to 12 weeks and cases may be reviewed retrospectively for.
sanofi pasteur inc. patient assistance program phone: (866) 801-5655 fax: (866) 734-7371 instructions: â­ both the patient and health-care provider will be responsible for completing their appropriate sections of the application. â­ patient and health-care provider must sign the application for each request.