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  • Express Scripts Prescription Fax Form - Guidestone Insurance

Get Express Scripts Prescription Fax Form - Guidestone Insurance

9525 Katy Freeway, Suite 312 Houston, TX 77024 Tel: (713) 4639449 Fax: (713) 4637181Refill Request Form Date: / / Patient Name: DOB: Patient Tel: Address: Pharmacy: Pharmacy Tel: Pharmacy Fax: Medication.

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Your provider can also fax your prescription to Express Scripts® Pharmacy — they can call (888) 327-9791 for faxing instructions. Be sure to give them your member ID number. (Only providers can fax prescriptions.)

A: For new prescriptions, you can have the Express Scripts Pharmacy deliver it (with free standard shipping) by visiting express-scripts.com/90day. You can also fill your 90-day prescriptions at a Walgreens or Duane Reade pharmacy.

GoodRx compensates Express Scripts. When GoodRx is offered within the pharmacy benefit, its will make a payment back to Express Scripts (PBM #2 above) whenever the patient's out-of-pocket cost with the discount card is lower than their out-of-pocket cost via the Express Script-managed benefit plan.

CVS and Safeway pharmacies participate in your plan's Smart90 network. To locate one, visit Express-Scripts.com and click “Locate a pharmacy” from the menu under “Manage Prescriptions,” Smart90 network pharmacies will be noted in your search results. Or, call Express Scripts at 800.988. 4125.

Depending on your plan, you received either a prescription benefit ID card or a combined ID card for both your medical and prescription benefits. You can find your member ID number on this card.

Please show your Express Scripts member ID card to your pharmacist when filling a prescription for yourself or a covered family member. You will also be able to access your member ID card anytime from your Smartphone if you download the Express Scripts Mobile App.

Prior authorization ensures that you get the prescription drug that is right for you and that is covered by your benefit. If it's determined that your plan doesn't cover the drug you were prescribed, you can ask your doctor about getting another prescription that is covered. You'll receive it for your plan's copayment.

Please call us at 800.753. 2851 to submit a verbal prior authorization request if you are unable to use Electronic Prior Authorization. Prior Authorization criteria is available upon request.

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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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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