Skip to main content

Pharmacy Forms

PDF  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.

PDF  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

PDF  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