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Mail order prescription physician fax form. Before you send us a prescription and to minimize any delays or outreach…. Use this form to order a new mail service prescription by fax from the prescribing physician’s office.
- NEW PRESCRIPTION Fax 1-800-491-7997 PHYSICIAN FAX ORDER FORM - OptumRx
Use this form to order a new mail service prescription by...
- Submitting a prescription to Optum Home Delivery
Optum Home Delivery (OptumRx Mail Service) 6800 W 115th St,...
- New home delivery prescription order form - OptumRx
Mail this completed order form with your new prescription(s)...
- Ordering prescriptions - OptumRx
Please order at least 21 days before you need your medicine....
- NEW PRESCRIPTION Fax 1-800-491-7997 PHYSICIAN FAX ORDER FORM - OptumRx
Use this form to order a new mail service prescription by fax from the prescribing physician’s office. Member completes section 1, while the physician completes sections 2 and 3. This fax is void unless received directly from physician’s office. To contact Optum Rx, physicians may call 1-800-791-7658.
Optum Home Delivery (OptumRx Mail Service) 6800 W 115th St, Suite 600 Overland Park, KS 66211-9838 NCPDP: 1718634 Call 1-800-791-7658 – Provide a verbal prescription directly to an Optum Rx provider dedicated pharmacist. Fax 1-800-491-7997 – Send a complete prescription using the Physician Fax Form.
Physician’s line: 1-800-791-7658 Sign and fax back to: 1-800-491-7997 [alt fax: 1-760-476-0406] This document and others if attached contain information from Optum Rx that is proprietary, confidential and/or may contain protected health information (PHI).
Mail this completed order form with your new prescription(s) to Optum Rx, P.O. Box 2975, Mission, KS 66201. Do not staple or tape prescriptions to the order form.
Please order at least 21 days before you need your medicine. Online – Go to the My Medicine Cabinet page and have copayments charged to a credit card. By Mail – All orders are mailed with a reorder form. Just check the medications you want to refill and mail the form back to our mail order pharmacy, along with a check or your credit card ...
Optum® Home Delivery mail-order form – English (pdf) Optum® Home Delivery mail-order form – Spanish (pdf) Claim form – Commercial (pdf) Claim form – Medicare Part D (pdf) Tools. Pricing and coverage tool. Find a network pharmacy. Prescription Drug List. Information center.
