CanadaRx now provides pharmacy services for patients belonging to certain HMO's, TPA's, PBM's, Union's and Large Corporations.

At CanadaRx.com, we are dedicated to providing our patients access to safe and affordable prescription medications from Canada and from around the world. There are over 43 million un-insured or under-insured citizens in the United States that require prescription medications. Law makers in the United States refuse to address the health care crisis and the drug companies refuse to give up the record profits.

CanadaRx.com has recognized this crisis and we have expanded our services for the millions of American's that are forced to decide between food and medication on a daily basis. We can now provide pharmacy services for patients belonging to certain HMO's, TPA's, PBM's, Union's and Large Corporations.

CAN WE HELP YOUR MEMBERS OBTAIN PRESCRIPTION DRUGS AT A FRACTION OF THE COST?

If you are one of these entities and are interested in speaking to one of our insurance specialists to see how we can provide affordable prescription medications to member patients please select OPTION 1.

DO WE HAVE A CONTRACT WITH YOUR CURRENT INSURANCE CARRIER?

If you are a patient with an insurance plan offering drug coverage and would like to use our pharmacy services please select OPTION 2 and we will inform you if we currently have a contract with your carrier.

HMO FORM OPTION 1

CanadaRx.com can now provide pharmacy services to patients belonging to HMO's, TPA's, PBM's, Unions, and Large Corporations that provide benefit packages.

If you are interested in CanadaRx providing this service for your Organization, please fill out this form.

*Denotes Required Fields

Company Name:	*
Website Operating  Name:
Street Address:	*
City:	*
State:	*
Zip Code:	*
Your Groups Entity:	-- Please Click Arrow to Select -- HMO TPA PBM Union Large Corporation Other - Please Specify Below *
Please tell us about  your company or group:	*
Your Email:	*
Phone:	*

*Additional Company Contacts: Required
Name	Phone	Fax	Email
1.
*Does your company currently operate a commercial website?
Yes		No
Please only press the submit button once.

HMO FORM OPTION 2

Contacting Us

If you are a patient with an insurance plan offering drug coverage and would like to use our pharmacy services, please complete to find out if we have a contract with your insurance carrier.

DUE TO THE VOLUME OF QUESTIONS RESULTING FROM RECENT MEDIA COVERAGE ONLY PATIENTS WITH PLANS THAT WE CAN PROCESS PRESCRIPTIONS FOR AND DIRECTLY BILL THE INSURANCE CARRIER WILL BE CONTACTED.

Full Name:	*
Street Address:	*
City:	*
State:	*
Zip Code:	*
Your Email:	*
Phone:	*
Insurance Company:	*
Insurance Type:	*
Questions or Comments:

Please only press the submit button once.