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Processing Information

Mar 31, 2018

BIN#: 610020 PCN#: PDM or PDMI

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Forms To Submit

Mar 31, 2018

  PRIOR AUTHORIZATION FORM

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Medication Formularies

Mar 31, 2018

  2024 Medication Formulary    

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Is My Pharmacy Contracted?

Mar 31, 2018

Use our pharmacy locator to search for your pharmacy. If your pharmacy does not show in the list, contact our benefits team to join the network.   Pharmacy Locator

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Rx Coverage Without Insurance

Mar 31, 2018

Provide patients with affordable medications even without insurance. The Prescription Discount Program is a cost-effective option for anyone paying out of pocket. Group #: URX22 BIN #: 610020 PCN #: URX001

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