Optumrx Mail Order Form. Prescription order form (pdf) (743.42 kb) for more information about home delivery with optumrx, visit the optumrx education center. Member and physician information — please use black or blue ink.
Optumrx Mail Order Pharmacy Phone PharmacyWalls
Do not staple or tape prescriptions to the order form. Prescription order form (pdf) (743.42 kb) for more information about home delivery with optumrx, visit the optumrx education center. Web new home delivery prescription order form 1. Open pdf, opens in a new tab or window. Member and physician information — please use black or blue ink. Do not staple or tape prescriptions to the order form. Verify the medication is covered by your patient’s health care plan or if. Open pdf, opens in a new tab or window. Add $20.00 to order amount (subject to change). Web mail this completed order form with your new prescription(s) to optumrx, p.o.
# city state zip code phone number with area code Box 2975, mission, ks 66201. Find answers to all your pharmacy questions, too. Open pdf, opens in a new tab or window. Before you send us a prescription and to minimize any delays or outreach… verify with your patient optumrx is their home delivery pharmacy; Box 2975, mission, ks 66201. Web get your medications at a low price, safely and conveniently. Member id number (additional coverage, if applicable) secondary member id number last name first name mi delivery address apt. Prescription order form (pdf) (743.42 kb) for more information about home delivery with optumrx, visit the optumrx education center. Click on the sign tool and make a signature. Do not staple or tape prescriptions to the order form.
