Serve You Rx Provider Agreement Request

Thank you for your interest in joining the Serve You Rx retail pharmacy network. To begin the provider approval process, please complete the following form. Upon receipt, the Serve You Rx Provider Services team will review and verify all necessary credentials and qualifications upon receipt. A Serve You Rx Provider Agreement will then be sent within 48 hours following approval of your request. If you wish to have the form faxed or emailed to you, please include your fax number or email address, as applicable; otherwise the Provider Agreement will be mailed. You may also call 800-759-3203 to request a Provider Agreement.

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