Join our network
Our Network is Growing
Join our network
Our Network is Growing
Join our network
Our Network is Growing
Join our network
Our Network is Growing
QUESTIONS
QUESTIONS
QUESTIONS
QUESTIONS
Reach Our Pharmacy Network Team
Have questions about contracting, reimbursement, or payments? Reach out to our team.
Pharmacy Resources
Forms And Documents
Pharmacy Resources
Forms And Documents
Pharmacy Resources
Forms And Documents
Pharmacy Resources
Forms And Documents
Forms & Documents
Forms & Documents
Forms & Documents
Forms & Documents
Electronic Funds Transfer (EFT) And Electronic Remittance Advice (ERA) Enrollment Form
Electronic Funds Transfer (EFT) And Electronic Remittance Advice (ERA) Enrollment Form
Electronic Funds Transfer (EFT) And Electronic Remittance Advice (ERA) Enrollment Form
Electronic Funds Transfer (EFT) And Electronic Remittance Advice (ERA) Enrollment Form
Payer Sheet
Payer Sheet
Payer Sheet
Payer Sheet
Provider Manual
Provider Manual
Provider Manual
Provider Manual
Reimbursement And MAC Appeal Form
Reimbursement And MAC Appeal Form
Reimbursement And MAC Appeal Form
Reimbursement And MAC Appeal Form
State-Specific
State-Specific
State-Specific
State-Specific
State-Specific Forms & Docs
State-Specific Forms & Docs
State-Specific Forms & Docs
State-Specific Forms & Docs
State-Specific Reports
State-Specific Reports
State-Specific Reports
State-Specific Reports
![](data:image/svg+xml,<svg display="block" role="presentation" viewBox="0 0 1637 493" xmlns="http://www.w3.org/2000/svg"><g d="M 113 0 L 1505 0 L 1505 493 L 113 493 Z M 1206.96 115.584 C 1228.97 105.87 1256.32 107.474 1279.18 111.095 C 1307.06 115.513 1334.96 126.359 1355.12 146.719 C 1356.74 148.355 1358.37 150.229 1358.62 152.518 C 1360.87 173.943 1315.29 171.861 1303.43 171.363 C 1275.11 170.164 1247.4 163.282 1220.65 154.227 C 1202.89 148.214 1170.37 134.899 1186.18 110.895 C 1195.44 96.843 1219.33 91.243 1238.21 90.736 C 1269.55 89.901 1301.9 94.965 1330.75 107.476 C 1343.29 112.91 1375.37 127.727 1371.18 146.319 C 1371.16 146.44 1360.47 193.86 1360.47 193.86 C 1338.74 206.861 1311.62 206.155 1287.33 203.392 C 1258.21 200.08 1229.08 194.523 1202.05 182.883 C 1194.08 179.447 1185.87 174.283 1180.48 167.378 C 1176.49 162.264 1171.97 144.703 1183.55 144.354 C 1185.72 144.288 1187.67 145.878 1188.68 147.797 C 1193.11 156.178 1188.16 167.037 1186.27 175.398 C 1183.98 185.499 1181.69 195.605 1179.39 205.703 C 1171.63 239.743 1165.37 274.105 1157.72 308.176 C 1153.32 327.776 1150.32 347.87 1142.89 366.646 C 1134.7 387.362 1128.4 401.869 1107.678 418.009 C 1086.12 434.802 1060.914 432.121 1047.263 425.589 C 980.993 393.862 1017.606 322.105 1045.109 311.744 C 1066.796 303.578 1106.259 327.384 1092.854 359.409 C 1076.18 399.228 1002.877 384.752 983.405 338.233 C 973.262 314 975.17 256.753 1022.944 241.299 C 1146.73 201.271 1122.38 122.653 1100.533 104.688 C 1069.494 79.174 978.785 39.485 961.949 198.97 C 949.596 315.977 832.822 325 764 255 C 539.837 27 366 285 0 175.398 M 1247.39 146.16 L 1255.99 131.301 L 1264.11 118.07 C 1264.11 118.07 1291.31 120.745 1294.53 125.585 C 1297.74 130.425 1294.59 136.165 1282.55 137.544 C 1272.19 138.731 1256.41 131.733 1256.41 131.733 M 1298.86 171.796 L 1278.55 137.761 M 1271.61 159.024 L 1304.57 144.769 M 1332.86 264.249 L 1345.84 199.704 M 1230.82 318.951 C 1258.71 323.179 1283.54 311.975 1286.27 293.927 C 1289.01 275.879 1268.62 257.82 1240.73 253.592 C 1212.84 249.364 1188.02 260.568 1185.28 278.616 C 1182.54 296.664 1202.93 314.723 1230.82 318.951 Z M 1196.8 319.082 C 1195.418 318.154 1194.092 317.143 1192.83 316.057 C 1191.14 314.602 1190.23 313.286 1190.23 313.286 C 1184.78 306.889 1182.1 299.575 1183.21 292.269 L 1185.28 278.635 M 1286.27 293.94 L 1284.2 307.575 C 1284.2 307.575 1281.94 319.884 1274.98 324.926 C 1264.14 332.78 1243.62 331.226 1243.62 331.226 M 1254.42 287.038 L 1259.45 287.805 M 1212.72 280.716 L 1217.74 281.482 M 1229.22 274.894 C 1224.23 274.179 1219.64 276.709 1218.49 280.662 C 1218.303 281.366 1218.196 282.09 1218.17 282.818 C 1218.13 284.606 1218.99 286.472 1220.36 287.977 C 1221.98 289.736 1224.25 290.866 1226.75 291.168 C 1232.49 291.858 1235.38 288.594 1238.18 285.437 C 1240.72 282.575 1243.34 279.612 1248.07 280.312 C 1249.72 280.555 1251.39 281.467 1252.53 282.746 C 1253.43 283.764 1253.94 284.908 1254.01 286.047 C 1254.05 286.809 1253.73 287.892 1253.73 287.892 C 1252.73 290.759 1249.7 292.095 1246.35 291.628 M 1278.36 322.454 C 1286.68 328.269 1293.79 335.829 1298.79 344.682 C 1302.65 351.5 1306.34 360.828 1303.25 368.606 C 1294.71 390.059 1262.13 374.727 1249.32 366.931 M 1292.4 405.664 C 1292.15 401.634 1282.2 393.495 1272.91 390.311 M 1636.92 127.638 C 1635.48 150.413 1601.45 191.912 1521.11 198.31 C 1500.4 199.956 1464.56 192.994 1446.75 200.423 M 1446.75 200.423 C 1429.76 207.507 1413.08 239.441 1436.84 256.118 C 1447.26 263.436 1461.82 259.346 1467.14 251.772 C 1479.83 233.735 1471.98 207.308 1446.75 200.423 Z M 1446.75 200.423 C 1439.33 198.399 1431.48 198.726 1423.87 199.852 C 1332.98 213.363 1302.16 417.522 1301.41 421.431 C 1297.45 442.014 1270.86 443.587 1254.22 443.872 C 1230.77 444.274 1152.2 432.747 1143.1 399.997 C 1141.83 395.423 1143.96 390.527 1144.74 385.913 M 1265.28 335.117 L 1261.42 330.259 M 1286.09 364.78 L 1281 357.884 M 1271.56 355.017 C 1273.72 358.091 1277.44 359.298 1280.18 357.896 C 1280.658 357.638 1281.104 357.326 1281.51 356.965 C 1282.5 356.07 1283.07 354.654 1283.19 353.139 C 1283.31 351.36 1282.77 349.55 1281.65 348.039 C 1279.09 344.565 1275.84 344.659 1272.7 344.751 C 1269.85 344.836 1266.89 344.922 1264.86 341.998 C 1264.15 340.975 1263.79 339.601 1263.9 338.33 C 1263.99 337.321 1264.35 336.461 1264.93 335.839 C 1265.33 335.43 1266.08 335.041 1266.08 335.041 C 1268.15 334.119 1270.42 335.087 1271.88 337.14 M 1177.23 324.752 C 1168.65 327.885 1162.42 333.472 1160.39 340.919 C 1156.09 356.737 1172.42 374.959 1196.86 381.606 C 1221.31 388.26 1244.61 380.826 1248.92 365.009 C 1252.89 350.425 1242.48 331.101 1218.04 326.089 C 1218.04 326.089 1201.7 322.76 1192.09 323.954 M 1157.14 352.866 L 1160.39 340.918 M 1239.93 391.791 C 1225.74 402.876 1203.62 401.333 1191.79 394.777 M 1221.21 355.56 L 1225.62 356.758 M 1184.66 345.614 L 1189.07 346.811 M 1199.98 342.122 C 1195.61 340.968 1191.25 342.747 1189.81 346.162 C 1189.569 346.77 1189.398 347.403 1189.3 348.05 C 1189.09 349.64 1189.65 351.396 1190.73 352.877 C 1191.98 354.609 1193.89 355.857 1196.09 356.382 C 1201.15 357.591 1204.07 354.975 1206.89 352.451 C 1209.45 350.156 1212.09 347.789 1216.24 348.897 C 1217.69 349.285 1219.08 350.267 1219.97 351.532 C 1220.67 352.531 1221 353.603 1220.95 354.629 C 1220.91 355.315 1220.51 356.249 1220.51 356.249 C 1219.32 358.709 1216.49 359.58 1213.54 358.818 M 1248.91 365.007 L 1243.99 380.398 M 1157.14 352.866 C 1157.14 352.866 1154.03 374.293 1156.53 379.218 C 1159.03 384.143 1168.65 386.839 1168.52 378.191 C 1168.43 371.642 1158.78 373.443 1154.95 374.729 C 1147.8 377.129 1140.83 384.861 1146.11 392.349 C 1157.41 408.348 1181.39 416.513 1199.38 421.906 C 1214.06 426.299 1229.3 428.824 1244.61 429.345 C 1258.21 429.81 1273.56 429.296 1285.21 421.278 M 1249.91 383.371 C 1249.91 383.371 1268.29 392.65 1281.31 389.53 C 1289.66 387.527 1299.86 374.181 1299.86 374.181" fill="transparent" height="493px" id="VK6EKgn1Z" width="1636.920061035156px"><path d="M 0 0 L 1392 0 L 1392 493 L 0 493 Z" fill="transparent" height="493px" id="u1_Pfjzbj" transform="translate(113 0)" width="1392px"/><path d="M 1206.96 34.739 C 1228.97 25.025 1256.32 26.629 1279.18 30.25 C 1307.06 34.668 1334.96 45.514 1355.12 65.874 C 1356.74 67.51 1358.37 69.384 1358.62 71.673 C 1360.87 93.098 1315.29 91.016 1303.43 90.518 C 1275.11 89.319 1247.4 82.437 1220.65 73.382 C 1202.89 67.369 1170.37 54.054 1186.18 30.05 C 1195.44 15.998 1219.33 10.398 1238.21 9.891 C 1269.55 9.056 1301.9 14.12 1330.75 26.631 C 1343.29 32.065 1375.37 46.882 1371.18 65.474 C 1371.16 65.595 1360.47 113.015 1360.47 113.015 C 1338.74 126.016 1311.62 125.31 1287.33 122.547 C 1258.21 119.235 1229.08 113.678 1202.05 102.038 C 1194.08 98.602 1185.87 93.438 1180.48 86.533 C 1176.49 81.419 1171.97 63.858 1183.55 63.509 C 1185.72 63.443 1187.67 65.033 1188.68 66.952 C 1193.11 75.333 1188.16 86.192 1186.27 94.553 C 1183.98 104.654 1181.69 114.76 1179.39 124.858 C 1171.63 158.898 1165.37 193.26 1157.72 227.331 C 1153.32 246.931 1150.32 267.025 1142.89 285.801 C 1134.7 306.517 1128.4 321.024 1107.678 337.164 C 1086.12 353.957 1060.914 351.276 1047.263 344.744 C 980.993 313.017 1017.606 241.26 1045.109 230.899 C 1066.796 222.733 1106.259 246.539 1092.854 278.564 C 1076.18 318.383 1002.877 303.907 983.405 257.388 C 973.262 233.155 975.17 175.908 1022.944 160.454 C 1146.73 120.426 1122.38 41.808 1100.533 23.843 C 1069.494 -1.671 978.785 -41.36 961.949 118.125 C 949.596 235.132 832.822 244.155 764 174.155 C 539.837 -53.845 366 204.155 0 94.553" fill="transparent" height="349.7996332642311px" id="wBgIiSQ4n" stroke-dasharray="" stroke-linecap="round" stroke-linejoin="round" stroke-width="3" stroke="rgb(254, 224, 205)" transform="translate(0 80.845)" width="1371.5545727671818px"/><path d="M 62.357 28.09 L 70.957 13.231 L 79.077 0 C 79.077 0 106.277 2.675 109.497 7.515 C 112.707 12.355 109.557 18.095 97.517 19.474 C 87.157 20.661 71.377 13.663 71.377 13.663 M 113.827 53.726 L 93.517 19.691 M 86.577 40.954 L 119.537 26.699 M 147.827 146.179 L 160.807 81.634 M 45.787 200.881 C 73.677 205.109 98.507 193.905 101.237 175.857 C 103.977 157.809 83.587 139.75 55.697 135.522 C 27.807 131.294 2.987 142.498 0.247 160.546 C -2.493 178.594 17.897 196.653 45.787 200.881 Z" fill="transparent" height="201.77322279737515px" id="KQX_Vbc7c" stroke-dasharray="" stroke-linecap="round" stroke-linejoin="round" stroke-width="3" stroke="rgb(254, 224, 205)" transform="translate(1185.033 118.07)" width="160.80678222656252px"/><path d="M 13.837 44.309 C 12.455 43.38 11.129 42.37 9.867 41.284 C 8.177 39.829 7.267 38.513 7.267 38.513 C 1.817 32.116 -0.863 24.802 0.247 17.496 L 2.317 3.862 M 103.307 19.167 L 101.237 32.802 C 101.237 32.802 98.977 45.111 92.017 50.153 C 81.177 58.007 60.657 56.453 60.657 56.453 M 71.457 12.265 L 76.487 13.032 M 29.757 5.943 L 34.777 6.709 M 46.257 0.121 C 41.267 -0.594 36.677 1.936 35.527 5.889 C 35.34 6.593 35.233 7.316 35.207 8.045 C 35.167 9.833 36.027 11.699 37.397 13.204 C 39.017 14.963 41.287 16.093 43.787 16.395 C 49.527 17.085 52.417 13.821 55.217 10.664 C 57.757 7.802 60.377 4.839 65.107 5.539 C 66.757 5.782 68.427 6.694 69.567 7.973 C 70.467 8.991 70.977 10.135 71.047 11.274 C 71.087 12.036 70.767 13.119 70.767 13.119 C 69.767 15.986 66.737 17.322 63.387 16.855" fill="transparent" height="56.577634135615156px" id="m5CyH5Q_o" stroke-dasharray="" stroke-linecap="round" stroke-linejoin="round" stroke-width="3" stroke="rgb(254, 224, 205)" transform="translate(1182.963 274.773)" width="103.30711975097643px"/><path d="M 29.04 0 C 37.36 5.815 44.47 13.375 49.47 22.228 C 53.33 29.046 57.02 38.374 53.93 46.152 C 45.39 67.605 12.81 52.273 0 44.477 M 43.08 83.21 C 42.83 79.18 32.88 71.041 23.59 67.857" fill="transparent" height="83.21000225830079px" id="WBq1s8fbd" stroke-dasharray="" stroke-linecap="round" stroke-linejoin="round" stroke-width="3" stroke="rgb(254, 224, 205)" transform="translate(1249.32 322.454)" width="55.08141207647634px"/><path d="M 494.215 0 C 492.775 22.775 458.745 64.274 378.405 70.672 C 357.695 72.318 321.855 65.356 304.045 72.785 M 304.045 72.785 C 287.055 79.869 270.375 111.803 294.135 128.48 C 304.555 135.798 319.115 131.708 324.435 124.134 C 337.125 106.097 329.275 79.67 304.045 72.785 Z M 304.045 72.785 C 296.625 70.761 288.775 71.088 281.165 72.214 C 190.275 85.725 159.455 289.884 158.705 293.793 C 154.745 314.376 128.155 315.949 111.515 316.234 C 88.065 316.636 9.495 305.109 0.395 272.359 C -0.875 267.785 1.255 262.889 2.035 258.275 M 122.575 207.479 L 118.715 202.621 M 143.385 237.142 L 138.295 230.246" fill="transparent" height="316.24411696167607px" id="J_pI3poqt" stroke-dasharray="" stroke-linecap="round" stroke-linejoin="round" stroke-width="3" stroke="rgb(254, 224, 205)" transform="translate(1142.705 127.638)" width="494.2151049804686px"/><path d="M 114.42 31.322 C 116.58 34.396 120.3 35.603 123.04 34.201 C 123.518 33.943 123.964 33.63 124.37 33.27 C 125.36 32.375 125.93 30.959 126.05 29.444 C 126.17 27.665 125.63 25.855 124.51 24.344 C 121.95 20.87 118.7 20.964 115.56 21.056 C 112.71 21.141 109.75 21.227 107.72 18.303 C 107.01 17.28 106.65 15.906 106.76 14.635 C 106.85 13.626 107.21 12.766 107.79 12.144 C 108.19 11.735 108.94 11.346 108.94 11.346 C 111.01 10.424 113.28 11.392 114.74 13.445 M 20.09 1.057 C 11.51 4.19 5.28 9.777 3.25 17.224 C -1.05 33.042 15.28 51.264 39.72 57.911 C 64.17 64.565 87.47 57.131 91.78 41.314 C 95.75 26.73 85.34 7.406 60.9 2.394 C 60.9 2.394 44.56 -0.935 34.95 0.259 M 0 29.171 L 3.25 17.223 M 82.79 68.096 C 68.6 79.181 46.48 77.638 34.65 71.082 M 64.07 31.865 L 68.48 33.063 M 27.52 21.919 L 31.93 23.116" fill="transparent" height="76.21504965331535px" id="zKurvrRsB" stroke-dasharray="" stroke-linecap="round" stroke-linejoin="round" stroke-width="3" stroke="rgb(254, 224, 205)" transform="translate(1157.14 323.695)" width="126.06642326981321px"/><path d="M 55.722 0.351 C 51.352 -0.803 46.992 0.976 45.552 4.391 C 45.311 4.999 45.14 5.632 45.042 6.279 C 44.832 7.869 45.392 9.625 46.472 11.106 C 47.722 12.838 49.632 14.086 51.832 14.611 C 56.892 15.82 59.812 13.204 62.632 10.68 C 65.192 8.385 67.832 6.018 71.982 7.126 C 73.432 7.514 74.822 8.496 75.712 9.761 C 76.412 10.76 76.742 11.832 76.692 12.858 C 76.652 13.544 76.252 14.478 76.252 14.478 C 75.062 16.938 72.232 17.809 69.282 17.047 M 104.652 23.236 L 99.732 38.627 M 12.882 11.095 C 12.882 11.095 9.772 32.522 12.272 37.447 C 14.772 42.372 24.392 45.068 24.262 36.42 C 24.172 29.871 14.522 31.672 10.692 32.958 C 3.542 35.358 -3.428 43.09 1.852 50.578 C 13.152 66.577 37.132 74.742 55.122 80.135 C 69.802 84.528 85.042 87.053 100.352 87.574 C 113.952 88.039 129.302 87.525 140.952 79.507 M 105.652 41.6 C 105.652 41.6 124.032 50.879 137.052 47.759 C 145.402 45.756 155.602 32.41 155.602 32.41" fill="transparent" height="87.69548943188421px" id="RODBMy13M" stroke-dasharray="" stroke-linecap="round" stroke-linejoin="round" stroke-width="3" stroke="rgb(254, 224, 205)" transform="translate(1144.258 341.771)" width="155.6023818969727px"/></g></svg>)
Pharmacy Support
Pharmacy Support
Pharmacy Support
Pharmacy Support
We’re Here to Help
Have an immediate question about eligibility? We have a team of experts ready to help.
Our Blog
Catch Up on the Latest News From Our Blog
Aug 14, 2025, 6:52 PM
Education
Real Savings vs. Discount Claims: What to Look for in PBM Reporting
It can be hard to determine what is real savings vs discount claims in the pharmacy industry. Learn about what to look for in PBM reporting here.
Aug 14, 2025, 6:52 PM
Read More
Aug 8, 2025, 5:38 PM
Education
What Is PBM Reform? Understanding Pharmacy Benefit Manager Changes
Explore PBM reform: its meaning, drivers, and how emerging transparent PBMs like SmithRx deliver better outcomes.
Aug 8, 2025, 5:38 PM
Read More
Aug 1, 2025, 12:15 PM
Education
Why Legacy PBMs Are Still Failing Employers
Legacy PBMs are still failing to evolve and offer effective, patient-first healthcare—leaving employers unsatisfied. Learn more here about legacy PBMs and the future of transparency.
Aug 1, 2025, 12:15 PM
Read More
Our Blog
Catch Up on the Latest News From Our Blog
Aug 14, 2025, 6:52 PM
Education
Real Savings vs. Discount Claims: What to Look for in PBM Reporting
It can be hard to determine what is real savings vs discount claims in the pharmacy industry. Learn about what to look for in PBM reporting here.
Aug 14, 2025, 6:52 PM
Read More
Aug 8, 2025, 5:38 PM
Education
What Is PBM Reform? Understanding Pharmacy Benefit Manager Changes
Explore PBM reform: its meaning, drivers, and how emerging transparent PBMs like SmithRx deliver better outcomes.
Aug 8, 2025, 5:38 PM
Read More
Aug 1, 2025, 12:15 PM
Education
Why Legacy PBMs Are Still Failing Employers
Legacy PBMs are still failing to evolve and offer effective, patient-first healthcare—leaving employers unsatisfied. Learn more here about legacy PBMs and the future of transparency.
Aug 1, 2025, 12:15 PM
Read More
Our Blog
Catch Up on the Latest News From Our Blog
Aug 14, 2025, 6:52 PM
Education
Real Savings vs. Discount Claims: What to Look for in PBM Reporting
It can be hard to determine what is real savings vs discount claims in the pharmacy industry. Learn about what to look for in PBM reporting here.
Aug 14, 2025, 6:52 PM
Read More
Aug 8, 2025, 5:38 PM
Education
What Is PBM Reform? Understanding Pharmacy Benefit Manager Changes
Explore PBM reform: its meaning, drivers, and how emerging transparent PBMs like SmithRx deliver better outcomes.
Aug 8, 2025, 5:38 PM
Read More
Aug 14, 2025, 6:52 PM
Education
Real Savings vs. Discount Claims: What to Look for in PBM Reporting
It can be hard to determine what is real savings vs discount claims in the pharmacy industry. Learn about what to look for in PBM reporting here.
Aug 14, 2025, 6:52 PM
Read More
Aug 8, 2025, 5:38 PM
Education
What Is PBM Reform? Understanding Pharmacy Benefit Manager Changes
Explore PBM reform: its meaning, drivers, and how emerging transparent PBMs like SmithRx deliver better outcomes.
Aug 8, 2025, 5:38 PM
Read More
Aug 1, 2025, 12:15 PM
Education
Why Legacy PBMs Are Still Failing Employers
Legacy PBMs are still failing to evolve and offer effective, patient-first healthcare—leaving employers unsatisfied. Learn more here about legacy PBMs and the future of transparency.
Aug 1, 2025, 12:15 PM
Read More
SmithRx is on a mission to reduce the complexity and costs of pharmacy benefits with radical transparency and cutting-edge technology.
Sales and Business
Pharmacy and Provider Line
Member Help
Connect
Awards
SmithRx is on a mission to reduce the complexity and costs of pharmacy benefits with radical transparency and cutting-edge technology.
Sales and Business
Pharmacy and Provider Line
Member Help
Connect
Awards
SmithRx is on a mission to reduce the complexity and costs of pharmacy benefits with radical transparency and cutting-edge technology.
Sales and Business
Pharmacy and Provider Line
Member Help
Connect
Awards
SmithRx is on a mission to reduce the complexity and costs of pharmacy benefits with radical transparency and cutting-edge technology.
Sales and Business
Pharmacy and Provider Line
Member Help
Awards
Company
Resources
Connect