How to Send a Prescription

Prescription Fax Line: 855-810-1932

• Fill out your office information & complete the required patient information at the top of the prescription request form
• Mark the box with the medication(s) you desire, the appropriate quantity, and day’s supply
• Sign the prescription request and fax the form and patient demographics (i.e. insurance and address information) to 920-268-1993

E-Prescribe

• Look for SmartScript Pharmacy under Retail Pharmacy or Mail-Order Pharmacy
• Select SmartScript Pharmacy
• If prompted, SmartScript NCPDPID is #5103091

What Happens After I Fax the Prescription to the Pharmacy?
Our pharmacy staff will contact your patient from our 844 area code to review their claim and to confirm their demographic information.  The medication is shipped to the patient’s home address.  We offer low cost shipping options.