Intake Forms

Forms to Get You Started

Please note: Banks Apothecary can accept only original prescription drug orders from patients. Faxed prescriptions can be accepted only from the prescribing practitioners.

Prior Authorization Forms

Aetna

Cigna-HealthSpring

Geisinger

Health Partner Plans

Keystone

UPMC

United Health Care

Specialty Drugs
Limited Distribution
Enrollment Forms
Order Refills