The Express Scripts fax system is secure and in compliance with HIPAA privacy standards. Page 2. This page was last updated on . © Express Scripts Holding ...
Mailing instructions are provided on the back of this form. FOLD HERE.
WOULD LIKE TO RECEIVE THEIR PRESCRIPTION MEDICATION BY MAIL.
Express Scripts Mail Order Form Fax : Useful Links
If my doctor faxes in a new prescription, do I still have to fax/mail in the prescription order form? No. If you wish to submit your prescription by fax, your doctor ...
militaryrx.express-scripts.com
Mail. Fill out the Home Delivery Order Form (PDF) and then mail the form and your 90-day prescription to the address listed on the form ...
Describes ways to send new prescriptions to Express Scripts for home delivery.
Fax: Have your doctor call 888.327.9791 for faxing instructions. (Faxes can only be accepted from a doctor's office.) Phone: Call Express Scripts at the toll- ...
The provision of the information requested on this form is for your patient's benefit.
militaryrx.express-scripts.com
We make it easy to share information Get your written prescriptions to us by using our mail order form. Find TRICARE claims forms, our medical questionnaire, ...
Mail the New Patient Mail Order Form and your prescriptions to: Express