Pharmacy Enrollment Form

IU Health Pharmacy Enrollment

Please complete the Pharmacy Enrollment Form below to begin the process of enrolling in an IU Health Pharmacy location. Alternatively, you can begin the process by having your provider(s) send new 90-day prescriptions to our pharmacy.

To streamline enrollment and prevent delays in the refill process, after submitting your enrollment:

  • Ask your provider(s) to change your preferred pharmacy so future prescriptions are sent to the appropriate IU Health Pharmacy instead of your previous pharmacy
  • Request your provider(s) sends new 90-day electronic prescriptions to your preferred IU Health Pharmacy location

Once your Pharmacy Enrollment Form is submitted, please allow 7-10 business days for processing. If you are currently out of medication or will need a refill earlier, we recommend you refill one more time at your current pharmacy.

Pharmacy Enrollment Form