This form is ONLY for pharmacies who want to join the Curative Retail Network. We are not currently accepting requests for our specialty or mail-order network.

Members requesting access to a pharmacy that's out of network will need to reach out to member services at 855-428-7284 to request a review of out of network pharmacies.

Requests do not guarantee inclusion into our network, and will be reviewed under the following criteria:

• Pharmacies in the area

• Current contracted rates through PSAO

• Business case

• Proof of Credentials: State Pharmacy License, PIC License, DEA Registration, Business LLC, and Tax ID/EIN (**which we will ask for if we proceed with next steps for network inclusion.**)

Submitted requests will be evaluated based on network needs and market considerations. Pharmacies selected for further consideration may be contacted to discuss potential participation and contracting terms.

Your pharmacy will receive a response shortly.