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Get Express Scripts Fax Form

Along with this completed form to: Express Scripts Home Delivery Service PO Box 66558 St. Louis MO 63166-6558 1. Both Dr/Prescriber and Rx Form boxes must be filled out. 2. Doctor can fax to: 1-800-837-0959 Class II prescriptions cannot be faxed. Faxes will only be accepted from a doctor s office. Stamped signatures cannot be accepted. PATIENT DOCTOR/PRESCRIBER Member ID: DEA: First Name:.

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