Referrals
Submit a Referral
Start the referral process by completing one of the forms below and sending it to our team. Select the appropriate form, fill it out, and submit it using email or fax.
Referrals
Submit a Referral
Start the referral process by completing one of the forms below and sending it to our team. Select the appropriate form, fill it out, and submit it using email or fax.
Referrals
Submit a Referral
Start the referral process by completing one of the forms below and sending it to our team. Select the appropriate form, fill it out, and submit it using email or fax.
Referrals
Submit a Referral
Start the referral process by completing one of the forms below and sending it to our team. Select the appropriate form, fill it out, and submit it using email or fax.
Need help or prefer to send it directly?
Need help or prefer to send it directly?
Need help or prefer to send it directly?
Need help or prefer to send it directly?
Email your completed form to help@pharmacy-x.com or call 201-796-0400
Email your completed form to help@pharmacy-x.com or call 201-796-0400
Email your completed form to help@pharmacy-x.com or call 201-796-0400
Email your completed form to help@pharmacy-x.com or call 201-796-0400
How It Works
How It Works
How It Works
A Simple Referral Process
A Simple Referral Process
A Simple Referral Process
A Simple Referral Process
From intake through coordination, our team manages each step quickly and clearly.
From intake through coordination, our team manages each step quickly and clearly.
From intake through coordination, our team manages each step quickly and clearly.
1
Download the Appropriate Form
Download the Appropriate Form
Download the Appropriate Form
Choose either the Hemophilia or IVIG referral form and complete all required patient and clinical details.
Choose either the Hemophilia or IVIG referral form and complete all required patient and clinical details.
2
Send the Referral
Send the Referral
Send the Referral
Email the completed form to: help@pharmacy-x.com or fax it to 201-796-0695.
Email the completed form to: help@pharmacy-x.com or fax it to 201-796-0695.
3
Care Coordination Begins
Care Coordination Begins
Care Coordination Begins
We review the referral, verify benefits, and contact the patient to begin services.
We review the referral, verify benefits, and contact the patient to begin services.
Questions before submitting? Call 201-796-0400.
Questions before submitting? Call 201-796-0400.
Questions before submitting? Call 201-796-0400.
Send completed forms to help@pharmacy-x.com or fax to 201-796-0695
Send completed forms to help@pharmacy-x.com or fax to 201-796-0695
Send completed forms to help@pharmacy-x.com or fax to 201-796-0695
Send a Referral
Send a Referral
Send a Referral
Send a Referral
Once your form is completed, send it using one of the options below.
Once your form is completed, send it using one of the options below.
Once your form is completed, send it using one of the options below.
Send completed forms and supporting documents to:
Send completed forms and supporting documents to:
Send completed forms and supporting documents to:
Fax
Fax
Phone Support
Phone Support
Questions or need assistance? Call
Questions or need assistance? Call
Questions or need assistance? Call
Delivering personalized, at-home infusion care with support every step of the way.
Stay up to date
Delivering personalized, at-home infusion care with support every step of the way.
Stay up to date
Delivering personalized, at-home infusion care with support every step of the way.
Stay up to date
Delivering personalized, at-home infusion care with support every step of the way.
Stay up to date
Delivering personalized, at-home infusion care with support every step of the way.
Stay up to date
Delivering personalized, at-home infusion care with support every step of the way.
Stay up to date