AscensionRxForm | Ascension

Coronavirus (COVID-19) Vaccine Update

Thank you for trusting us with your care. We are grateful for the overwhelmingly positive community response to receiving the COVID-19 vaccine. Many of our Ascension locations are beginning to provide the COVID-19 vaccine and will notify eligible patients as appointment times are made available. View vaccination updates for your local area. Appointments for the vaccine must be scheduled in advance. Persons without an appointment will not be able to receive the vaccine and walk-ins will not be available. We are working with local and state government and health agencies to help distribute vaccinations as they become available in our communities. Learn more about the COVID-19 vaccine.

Be Careful about Medicare Scams

Protect yourself and your loved ones by learning about the most common Medicare scams and how to determine whether communication from your doctor, your insurer or the Centers for Medicare & Medicaid Services (CMS) is legitimate. Scams claiming to be with Medicare are targeting patients and fraudulent activity tends to increase around the Medicare Open Enrollment period. Remember, if you get a phone call and you're even slightly suspicious, do not share your ID number, home address or other personal information. Hang up and call your doctor or Medicare at the number on your card. Report anything suspicious to Medicare. If you suspect fraud, call 1-800-MEDICARE.

Step 1: Set up an Ascension Rx account

The following states are currently not eligible: Arkansas, California, and Louisiana. Continue refilling your medication at your existing pharmacy if your state is currently not eligible. You will be contacted through your @ascension.org email when your state becomes available.

Plan Information

Policy Holder Full Name *

Who is this medication for? *

Who is this medication for? I am transfering prescriptions for myself. This prescription transfer is for a dependent.

First Name *

Last Name *

Date of Birth *

Month

Day

Year

Does this person have any medication allergies? * Yes No

If yes, please enter them below. *

Contact Information

Email *

Mobile Number *

Text message updates will be sent to this number.

Home Number (optional)

Preferred Time of Contact * Morning Afternoon Evening

Shipping Address *

Medications will be delivered to this address.

Shipping Address Line 2 (Optional)

City *

State *

Zip Code *

The following states are currently not eligible: Arkansas, California, and Louisiana. You will be contacted through your @ascension.org email when your state becomes available.

Communication preferences *

As a benefit of Ascension Rx, you will receive updates on your medication transfer via text message. View the full consent for electronic communications.

Communication Preferences Yes, I agree to receive text message updates on my medication transfer. No, I would not like to receive these updates.

Step 2: Talk to your prescriber

Please complete this form for each family member or dependent who is covered by SmartHealth.

Need help? Call 1-833-Meds-ARx

Want to change your preferred location? You'll then get information specific to your new service region.

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