Are you a provider who has a request?
Prescription Center welcomes provider requests for consideration of new specialty and compounded medication additions to our formulary. This form allows prescribers to submit medication requests for review by our clinical pharmacy team. Submissions are evaluated based on clinical appropriateness, safety, regulatory requirements, and operational feasibility.
Completion of this form does not guarantee approval. Providers who submit a request will receive updates regarding approval status, denial, or additional information needed, along with the rationale for the decision when applicable.
Provider Formulary Request Form