For Providers
Specialty referral forms.
Submitting a prescription to Priority Health Pharmacy is easy — choose the form that fits your patient's therapy and fax it to our team.
1
Download & complete
Open the form, fill in patient and prescription details, and attach any required clinical documentation.
2
Fax it to us
Send completed forms to 845-789-4104. Our team acknowledges every referral within one business day.
3
We take it from there
We reach out to your patient, coordinate onboarding, and enroll them in any available copay or assistance programs.
Cardiology & Pulmonology
Endocrinology
Hepatology
Immune Deficiencies
Neurology & Behavioral Health
Oncology & Hematology
Fax completed forms to 845-789-4104. Questions? Call 845-789-5648. Learn more about our provider partnership and disease therapy management or our full specialty pharmacy services. For accident or injury claims, see our New York No-Fault accident pharmacy and workers' compensation pharmacy services.
Related resources
Explore related pharmacy services and patient resources.
For Providers
Disease therapy management and compliance reporting.
Learn morePharmacy Services
Specialty, refills, transfers, and free delivery.
Learn moreWorkers' Comp Pharmacy
Direct carrier billing for work-injury prescriptions.
Learn moreFor Patients
What your patients can expect when they come to us.
Learn more