enrollsource.rpharm-us.comAccess and Support

For reimbursement support, contact R-Pharm US Access and Support in one of the following ways: Call the Support Center at 1-855-991-7277 , 8 AM to 8 PM ET, Monday through Friday Fax the Support Center at 1-877-541-7813 Download and complete the forms as directed below: Download PDF R-Pharm US enrollment form Enroll in R-Pharm US by completing this form with your doctor or nurse. Be sure to sign this form. If not signed, you must complete the patient authorization form below. Download PDF R-Pharm US patient authorization form If you did not sign the enrollment form above, complete this form to allow R-Pharm US to provide services. The information provided is intended for use by individuals involved with reimbursement support. The accurate completion of reimbursement or coverage-related documentation is the responsibility of the healthcare provider and patient. R-Pharm US and its agents make no guarantee regarding reimbursement for any service or item. The R-Pharm US Access and Support logo is a trademark of R-Pharm US Operating LLC, a wholly owned subsidiary of R-Pharm US LLC. © 2016, R-PHARM US. All rights reserved. RPH-00032 02/16...