Specialty Enrollment FormsPyramids Pharmacy 2026

1. Click ‘Get Form’ to open the Specialty Enrollment Form in the editor.
2. Begin by filling out the Patient Information section. Enter the patient's name, birthdate, social security number, sex, preferred phone number, height, weight, known allergies, and address details.
3. Next, complete the Insurance Information section. Ensure you have a front and back copy of all insurance cards ready to fax. Fill in the plan name, plan phone number, ID number, group number, RxBIN, and RxPCN.
4. Proceed to the Prescriber Information section. Input the prescriber's name, DEA number, address, NPI number, phone number, tax ID number, key contact information and fax details.
5. In the Diagnosis/Clinical Information section, select the appropriate diagnosis from the list provided and fill in any additional required fields such as TB test status and concomitant medications.
6. Finally, review all sections for accuracy before submitting your form through our platform for processing.

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