Authorize a pickup, quickly and securely.
Name someone you trust to collect your medication from our in-house pharmacy. This authorization applies to this pickup only — complete a new form each time someone else picks up on your behalf.
Authorized party full name and phone number
Photo ID must be presented at pick-up.
Your authorization is handled securely.
It’s reviewed by our care team and stored within your confidential member record.
Medication Pickup Authorization
Complete the form below. This authorization applies to this pickup only.