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  • Medimpact Pa Form

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Medication Request Form (MRF) c/o MedImpact Healthcare Systems, Inc. DO NOT WRITE IN BLOCKED AREAS FOR INTERNAL USE ONLY Contacted: Physician: Pharmacy: Patient: DO NOT WRITE IN BLOCKED AREAS FOR.

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Contact support

Birdi™ pharmacy, formerly known as MedImpact Direct Mail, makes it easy to manage the medicine you take to stay healthy. First, check with your employer or health plan to see if you are eligible.

For assistance with registration, login, username, and password reset, please contact Customer Support at (877) 403-6032 between the hours of 8am and 8pm Pacific Time. Our friendly staff is here to help.

The MedImpact Direct Specialty Program network includes Ardon Health, Biologics Specialty Pharmacy, Humana Specialty Pharmacy, Kroger Specialty Pharmacy, and US Bioservices. Call us toll-free at 1-877-391-1103 (TTY dial 711) 8 am to 8 pm Eastern Time, Monday-Friday.

MedImpact is a pharmacy benefit manager who works with your health plan to get you the medication you need.

For urgent or expedited requests please call 1-855-297-2870. This form may be used for non-urgent requests and faxed to 1-844-403-1029. OptumRx has partnered with CoverMyMeds to receive prior authorization requests, saving you time and often delivering real-time determinations.

To initiate an appeal, complete and submit this form to MedImpact's Appeal Coordinator at the address listed below. Or, fax it to the Appeal Coordinator at (858) 790 6060.

“MedImpact is, hands down, the best mail-order pharmacy I have ever worked with. Your customer service, website, accuracy of prescriptions, and speed of delivery is exemplary.” Reach out to our home delivery team to see if MedImpact Direct is right for your members.

Commercial health plans. We provide national, regional, and specialty health plans with integrated programs designed to reduce costs, streamline operations, and deliver a seamless member experience.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232