Enrollment Forms

Dear Patients and Healthcare Providers:

Welcome to Prime Aid Pharmacy. Whether this is your first order or you are long-term customer, please take a moment to review this booklet and the information enclosed regarding Prime Aid Specialty Pharmacy Services.

Please review the enclosed material. Action steps are required for all new customers:

1.Please sign and return the Prime Aid’s PRIVACY NOTICE in the postage paid envelope provided.

If you are a patient:

2. Please sign and return the Assignment of Benefits form in the envelope provided.

3. Patient Satisfaction Form / Complaint Form

4. Please sign and return the Patient Consent to Share Information form in the envelope provided.

Prime Aid Pharmacy’s mission is: we are an independently held healthcare company dedicated to being a customer focused and innovative partner, providing medication management and clinical services in a caring, cost-effective, supportive environment; keeping patients healthier longer…one patient at a time. We are Your Specialty Pharmacy!

If you have any questions or special requests for your prescriptions, please contact Customer Service at 800-731-4553. If you have after hours concerns about your medication or side effects, please call the After-Hours Hotline at 800-731-4553.

Sincerely,

Prime Aid Pharmacy Team

Welcome Package

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