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Express Scripts Canada fax number

(855) 712-6329

Clinical Services

Used for: Prior Authorization Form submission for medications requiring prior approval

Fax destination details

Department
Clinical Services
Purpose
Prior Authorization Form submission for medications requiring prior approval
Form
Prior Authorization Form — Prior Authorization Form
Address
6985 Financial Drive, Suite 300, Mississauga, ON L5N 0G3

Before you send

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  • Check the organization website or call its main line for the current fax number.
  • Include a cover sheet and any case, member, claim, or form reference required.
  • Keep the delivery confirmation with your submission records.

Complete Part A (patient) and Part B (prescribing physician) and fax the completed form to Express Scripts Canada Clinical Services at 1-855-712-6329 or mail to Express Scripts Canada Clinical Services, 6985 Financial Drive, Suite 300, Mississauga, ON L5N 0G3.

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