How to Make a Referral:

Thank you for thinking of us! Patients and physicians choose RE Pharmacy for our expertise, guidance, and personal touch. Payors rely on us for our partnership in providing their members with comprehensive care planning that follows this process:

  • Use our fax referral form (download here)
  • Fax the completed referral to RE Pharmacy or use e-prescriber (see specifics below)
  • RE Pharmacy will contact the physicians for additional information and quick turn around time
  • RE Pharmacy contacts patients and physicians for financial responsibility and medication delivery
  • RE Pharmacy contacts patient for medication consultation
  • RE Pharmacy contacts patient for follow-up post-dispensing

BY PHONE:

Contact us directly at:
866 413-3156 toll free phone

BY FAX:

RE Pharmacy Fax referral forms can be faxed during normal business hours at 877 834-1231 toll free fax

FAX COVER SHEETS

Review and download RE Pharmacy
Fax Referral Forms:

  • Simple Fax Cover Sheet (download)
  • All in One Fax Cover Sheet (download)
  • Use your own: RE Pharmacy will accept
    referrals using your own fax cover sheet

BY E-PRESCRIBE:

Riverside County

Re Pharmacy
36919 Cook St., Suite 102
Palm Desert, CA 92211
NABP# 5632763
NPI# 1689823486

Irvine

Re Pharmacy
17332 Von Karman Ave., Suite 110
Irvine, CA 92614
NPI# 1508315128
BOP license # 51942

REFERRAL FORMS

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Dermatology
Gastroenterology / Crohns
Hepatitis B
Hepatitis C
HIV / AIDS
IG - Autoimmune Disorder
IG - Primary Immune Deficiency
Immune Globulin (IG)
Multiple Sclerosis
Oncology
Osteoporosis
Pain Management
Rheumatology (Drugs A-K)
Rheumatology (Drugs L-R)
Rheumatology (Drugs S-Z)
OTEZLA FORM

OTHER FORMS

Download PDF
Email
Print
Simple Fax Referral

Special Note: Faxed prescriptions can only be accepted from the prescribing practitioner. If you are using the Fax Referral Form to self-refer to RE Pharmacy, a physician’s signature and original prescription drug order are required. If materials include Protected Health Information (PHI), these records are CONFIDENTIAL.