Pharmacy Forms

 Mail Service Pharmacy Registration & Order Form (Spanish) – PrimeMail by Walgreens Mail Service

Use este formulario para inscribirse/remitir su primera orden de receta. ID: W0321SP-1017

 Mail Service Registration & Prescription Order Form – PrimeMail by Walgreens Mail Service

Use this form to register or submit your first prescription order. ID: W0319-0817

 Prescription Drug Claim Form - Prime Therapeutics

Use this claim form for prescriptions filled by Prime Therapeutics. Prime Therapeutics LLC is an independent company providing pharmacy benefit management services for Horizon BCBSNJ members. ID: 3272