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  • Proact Claims Form

Get Proact Claims Form

Attach Pharmacy Receipt for each claim submitted Review, sign, and send to: ProAct Pharmacy Services, Inc 1230 US HWY 11 Gouverneur, NY 13642 Attn: DMR Dept. IMPORTANT: MISSING INFORMATION MAY CAUSE A DELAY IN PAYMENT. PART A Employee/Patient information Employee s Name: Last First Member # (on ID Car Patient s Name: Last First Relationship to Employee Employee s Street Address City Group ID#(on Card) Employer/Carrie State Employee s Daytime Phone # ( ) Zip Code Ple.

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The big three PBM companies are Express Scripts, CVS Caremark, and OptumRx. These companies dominate the market due to their extensive networks and resources. Comparing their services with ProAct can provide insights into different options available through the Proact Claims Form.

You can contact ProAct through their dedicated customer service line or via their official website. Their support team is available to assist with inquiries about benefits, claims, and more. For any specific questions related to submitting the ProAct Claims Form, their representatives will guide you through the process.

The ProAct discount is a structured savings program designed to provide members with lower prescription costs. It is particularly useful for individuals without insurance or those seeking alternatives to high-priced medications. By utilizing the ProAct Claims Form, users can make the most of these discounts available through the ProAct platform.

For assistance related to the Proact Claims Form, you can reach ProAct support at their dedicated phone number. It is essential to have your information ready when you call, as this will help the support team assist you efficiently. They are knowledgeable and ready to guide you through any questions or issues you may have.

You or your pharmacist should call ProAct's 24/7/365 Help Desk (1-877-635-9545) immediately for a resolution. Your physician can start the prior authorization review process by visiting proactrx.promptpa.com to obtain medication specific request forms.

Prior Authorization Form Navigator If you do not have the bin number please contact 1-877-635-9545.

ProAct, Inc. is a fully integrated pharmacy benefit management (PBM) company with a mail order pharmacy. At ProAct, we strive to produce innovative, affordable and flexible prescription drug benefit solutions for the client by combining industry-leading client service with the latest in PBM technology.

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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:
+1 833 426 79 33
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