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December 31, 2022

New prescription physician fax form

Use this form to order a new mail service prescription by fax from the prescribing physician’s office.

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November 11, 2022

Network participation request form

Join the OptumRx network today.

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September 30, 2022

Pharmacy Provider Relations Intake Form

Use this form to submit network rejections, pricing inquiries, and claim payment issues to Pharmacy Provider Relations.

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May 14, 2018

Long term care pharmacy attestation form

Use this form to enter your attestation to the CMS requirement.

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