Serve You - The Hand Crafted PBM


Formulary
Pharmacy Support
Provider Agreement
BIN # / Payor Sheet
Rx Benefit Insights
Prior Authorization Form
FAQ
Home Page

To request to become a provider in Serve You's network, please complete and submit the following information. A Provider Agreement will be sent to you within 48 hours of receipt. If you wish to have the form faxed to you, please include your fax number, otherwise the Agreement will be mailed. You may also call Serve You at 1-800-759-3203 to request a Provider Agreement.

Upon receipt of your signed Agreement, you will be eligible to submit claims within 24 hours. Complete transmission instructions for adjudication will be included with the Agreement.

Pharmacy Name:
NCPDP/NPI ID Number:
Address:
City:
State/Province:
Zip Code:
Phone Number:
Fax:
Contact Name:
Your Email Address:
Additional Info:




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