Form 1349, Drug Utilization Review Board Annual Disclosure

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Effective Date: 2/2022


Updated: 2/2022


Complete this form:

  1. When initially applying to be a member of the Drug Utilization Review (DUR) board.
  2. Upon your initial appointment to the board.
  3. Each year as part of the annual attestation Process.


Initial Application:

Appointment and Annual Attestation:


Direct any questions about this form to the Vendor Drug Program at