Pharmacy Forms
Mail Service Pharmacy Registration & Order Form (Spanish) – AllianceRx Walgreens Prime by Walgreens Mail Service
Use este formulario para inscribirse/remitir su primera orden de receta.
Mail Service Registration & Prescription Order Form – AllianceRx Walgreens Prime by Walgreens Mail Service
Use this form to register or submit your first prescription order. ID: W0319-1118
Prescription Drug/COVID-19 At-Home Test Kit Claim Form
Use this claim form to submit eligible pharmacy expenses for reimbursement, including COVID-19 at-home test kits you paid out of pocket for. You have to submit one claim form for each person and each prescription. Full instructions can be found on page 2. ID: 3272 NJ 03/22