Get Preferred Customer Card - Link.amerisourcebergen.com

This guide provides detailed instructions on how to fill out the Preferred Customer Card online, designed specifically for members of the Good Neighbor Pharmacy Provider Network. By following these steps, you can ensure a smooth enrollment process.

Follow the steps to complete your Preferred Customer Card enrollment.

1. Click ‘Get Form’ button to obtain the enrollment form and open it in your preferred editor.
2. Complete the cardholder information section. This includes providing your last name, first name, address, city, state, zip code, and date of birth. Ensure that all details are entered correctly.
3. Review the participating pharmacy information section. Fill in the pharmacy's name, NCPDP, address, city, state, zip code, phone number, and fax number accurately.
4. Select the appropriate group patient participation option by marking only one box. This determines the reimbursement level you wish to enroll in (A, B, C, or HI).
5. Once all required fields are filled out, review the completed form for any errors or missing information.
6. After verifying everything is correct, save your changes. You can then download, print, or share the filled enrollment form as necessary.
7. Fax the completed enrollment form to the Good Neighbor Pharmacy Provider Network at 845.483.1745 or email it to pccfaxes@amerisourcebergen.com for processing.

Complete your Preferred Customer Card enrollment online today for exclusive benefits.