ENROLLMENT FORMS

Find what you're looking for quickly and easily. Start by choosing your location. Then select the first letter of either the medication you're looking for or the conditions to be treated. The options with available forms will be highlighted. Then, just select the right form.

Step 1: Choose Location

U.S.
Puerto Rico

Step 2: Select the starting letter

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

For additional enrollment forms, please contact Sales Support at pghsalessupport@caremark.com

A

Alcohol Dependence

Alpha1 Proteinase Inhibitor Deficiency

Allergic Asthma

C

CAPS Syndrome

Crohn's Disease

Crohn's Disease

Cystic Fibrosis

Cystic Fibrosis

D

Dermatology/Psoriasis

F

Fertility (Mid West)

Fertility (National)

G

Gastroenterology

Gastroenterology

General (Blank) Caremark Specialty Enrollment Form

Growth Hormone Disorders

H

Hematopoietic: Hepatitis C

Hematopoietic: Hepatitis C

Hematopoietics

Hematopoietics

Hereditary Angioedema

HIV/Co-Infection

HIV/Co-Infection

I

Immune Disorders (General and IVIG)

L

Lysosomal Storage Disorders

M

Mirena/Skyla

Multiple Sclerosis

Multiple Sclerosis

O

Oncology Orals Hematologic Malignancies

Oncology Orals Hematologic Malignancies

Oncology Orals Medications Enrollment Form

Oncology Orals Medications Enrollment Form

Oncology Orals Solid Tumors

Oncology Orals Solid Tumors

Osteoarthritis

Osteoarthritis

P

Polmalyst/Revlimid/Thalomid

Polmalyst/Revlimid/Thalomid

Pulmonary Arterial Hypertension

R

Respiratory Syncytial Virus (RSV)

Respiratory Syncytial Virus (RSV)

Retinal Disorders/Ocular Specialty

Retinal Disorders/Ocular Specialty

Rheumatoid Arthritis

Rheumatology IV

Rheumatology IV

Rheumatology Subcutaneous

Rheumatology Subcutaneous

S

Specialty Pharmacy Services

U

Urology Oral Medications

Urology Oral Medications