Pharmacy Referral Forms
How To Get Your Patients Their Prescriptions
Choose From One of the Methods Below
E-PRESCRIBE
Encore accepts e-prescribing
on all medications. Using your local Encore NPI# under your retail tab in your EMR/EHR or standalone e-prescribing application.
FAX
As an alternative for hard copy prescriptions, you can fax your prescription form with a front and back copy of your patient’s benefit card to the pharmacy location on your referral form.
PHONE
Call one of our local
Encore Pharmacy locations.
Manufacturer Program
Support Your Patients That Have a History of Overt Hepatic Encephalopathy Indication
Encore Pharmacy offers free, next-day delivery of XIFAXAN.
Download Xifaxan Forms
Dallas / Fort Worth
El Paso
Houston
Mississippi
Download a Fillable PDF Referral Form
Qualifying prescribers can E-scribe, Fax, or Call to send prescription referrals to encore pharmacy.
Choose Your Preferred Pharmacy Location
Dallas / Fort Worth Referral Forms
Gastroenterology
Hepatitis C
HIV
Multiple Sclerosis
Neurology
Oncology
Men's Health ONC
Wound Care
El Paso Referral Forms
Gastroenterology
Hepatitis C
HIV
Multiple Sclerosis
Neurology
Oncology
Men's Health ONC
Wound Care
Houston Referral Forms
Gastroenterology
Hepatitis C
HIV
Multiple Sclerosis
Neurology
Oncology
Men's Health ONC
Wound Care
Mississippi Referral Forms
Gastroenterology
Hepatitis C
HIV
Multiple Sclerosis
Don't see a form you are looking for? Use the form below to submit your request.
Simply enter your contact information, select the location and form you would like to receive.
