To start service with MedImpact Direct Mail, you will need a 90-day supply prescription for your first custom delivery order. We will also need some other information, including your allergies, payment information and shipping address.
You have several options for getting your prescription to us: by phone, by mail, or have your provider send your prescription electronically via ePrescribe or by fax.
You can call MedImpact Direct toll-free at:
Monday - Friday 7am - 7pm (Central Time) Saturday 8am - 4pm (Central Time) Sunday Closed
Mail Us Your Prescription
You can print and complete this order form:
Download Order Form
You can print and complete this HIPAA release form:
Download HIPAA Release Form
Send it, along with your prescription, to the following address:
PO Box 51580
Phoenix, AZ 85076-1580
Have Your Provider Send Us Your Prescription Electronically
Your provider can submit your prescription electronically via ePrescribing or
he or she can fax it to:
We can only accept faxes from your healthcare provider. Once we receive the
prescription, we will contact you for your payment information and your shipping address.