Referral Forms for Providers in the State of Alabama
PLEASE CONSIDER SENDING YOUR PRESCRIPTIONS ELECTRONICALLY.
ALL OF YOUR PHARMACY LOCATIONS ACCEPT ELECTRONIC PRESCIPTIONS
Should your patient choose to use AllianceRx Walgreens Pharmacy, please fax this form to one of the locations below:
Canton, MI-Phone: 888-282-5166 Fax: 888-570-4700
Pittsburgh, PA-Phone: 877-235-9798 Fax: 877-235-9807
Frisco, TX-Phone: 800-424-9002 Fax: 888-380-6181
(Cystic Fibrosis) Frisco, TX-Phone: 800-541-4959 Fax: 800-263-0251*
*Should your patient choose to use Walgreens Community Based Specialty Pharmacy, please provide this form to your patient
The prescriber is to comply with his/her state prescription requirements such as e-prescribing, state specific prescription form, fax language, etc. Non-compliance with state specific requirements could result in outreach to the prescriber.