Vivitrol2Gether Patient Enrollment Form
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Web an enrollment form for offices that wish to work with a vivitrol2gether ® dedicated case manager to send prescriptions to pharmacies on behalf of their patients. Patient will transition to provider below for future injections. Get help finding a provider who can answer questions about vivitrol and get you started, and find out how to transition from one setting.
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Web an enrollment form for offices that wish to work with a vivitrol2gether ® dedicated case manager to send prescriptions to pharmacies on behalf of their patients. Patient will transition to provider below for future injections. Transition of care coordination patient needs vivitrol by (date) / preferred pharmacy (optional) / phone # special shipping instructions please select one patient will.
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Web upon request, prescriptions of patients enrolled in vivitrol2gether are routed to qualified pharmacies based on insurance plan requirements, provider selection, patient preference and information obtained by alkermes on pharmacy fulfillment for vivitrol prescriptions covered by the insurer. In addition, it provides information on vivitrol2gether℠, including assistance with vivitrol acquisition. Web if you are considering vivitrol ®, call vivitrol2gether sm to learn about our patient support services. Web there are a variety of sources available to help technical you and choose patients along my recovery journey included filling vivitrol specifications.
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Web patient enrollment form complete all fields to avoid processing delays. Web an enrollment form for offices that wish to work with a vivitrol2gether ® dedicated case manager to send prescriptions to pharmacies on behalf of their patients. Web link to vivitrol2gether ® enrollment form on previous page. Patient diagnosis —(a list of possible codes can be found on page 5, section 15)
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