Pharmacy Provider Relations Intake Form
Use this form to submit network rejections, pricing inquiries, and claim payment issues to Pharmacy Provider Relations
ORx PPR Intake Form V3.2
- You must review the attached INSTRUCTION TABLE for Intake Form Guidelines.
- If you require assistance with filling out the Intake form, you may request a meeting so that our team can do an overview.
- For additional questions or to set up a meeting, contact our team at firstname.lastname@example.org.