Thank you for your interest in signing up for electronic payments and remittances!
Please be sure to complete the forms entirely. Move your pointer over the question mark [?] for an explanation of what information is being requested.
If you have any questions about these instructions or are unsure of how to complete these authorizations you may email your questions to PharmacyPayables@envisionrx.com or call us toll free at 1-800-361-4542 and ask for pharmacy payables.
Once you have submitted these forms on line be sure to send us a copy of a voided check or a letter on bank letterhead so we can confirm your routing/account numbers. Be sure to include your NCPDP number so we can match this with your authorization. This information can be emailed to PharmacyPayables@envisionrx.com, faxed to 330-486-4801 (Attn: Pharmacy Payables), or mailed to EnvisionRx (Attn: Pharmacy Payables), 8957 Canyon Falls Blvd, Twinsburg, OH 44087.