Have your prescriptions delivered at home through Intermountain Healthcare's prescription Home Delivery program. To enroll, please complete and submit the form below. After submitting, Intermountain Healthcare will contact you to determine your method of payment.
Also, in regards to the section of the form titled, "Pharmacy and Physician Information," we are happy to get your prescriptions transferred from your current pharmacy. If your prescriptions are out of refills, we request that you contact your doctor to request the medications. Please note that some doctor offices, as a means of protecting your Personal Health Information (PHI), request notice that you are switching pharmacies.
For patient safety, one enrollment form is required for each patient.