Thank you for choosing Summit Pharmacy.
1.) Fill out online enrollment form with patient information, or download PDF and fax to
(877 678 5401)

mail to:
2432 W. Peoria Ave., Suite 1286
Phoenix, AZ 85029,
or call 877-678-5400.

2.) Fax or Fed Ex Prescription, along with enrollment form, directly to Summit Pharmacy. Summit must receive original prescription for all Schedule II narcotic medications only. Summit will provide prepaid Fed Ex envelopes and arrange all pick-up and delivery.

DO NOT GIVE THE PRESCRIPTION TO YOUR PATIENT.

*New Jersey & Delaware physicians must include Assignment of Benefits (AOB) and Letter of Protection (LOP) forms when enrolling motor vehicle accident patients.

WORK ACCIDENT ENROLLMENT
SUMMIT ENROLLMENT PDF
SUMMIT ONLINE ENROLLMENT

AUTO ACCIDENT ENROLLMENT
SUMMIT ENROLLMENT PDF
SUMMIT ONLINE ENROLLMENT


BENEFITS OF USING SUMMIT PHARMACY