Vivitrol Enrollment Form

Vivitrol Enrollment Form - Utilize the portal to register and submit. Prescriber signature(s) (section 7 & 8) and patient signature(s) (section 13) required. Web check your eligibility today in just 3 steps. 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.

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Prescriber signature(s) (section 7 & 8) and patient signature(s) (section 13) required. 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 check your eligibility today in just 3 steps. Utilize the portal to register and submit.

Web Check Your Eligibility Today In Just 3 Steps.

Prescriber signature(s) (section 7 & 8) and patient signature(s) (section 13) required. 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. Utilize the portal to register and submit.

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