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Quality Specialty Pharmacy
  • Home
  • About
    • Locations >
      • Northeast
    • List of Services
    • About us
    • Copay Assistance
    • Frequently Asked Questions
    • Contact Us
  • Specialties
    • Dermatology
    • Gastroenterology
    • General
    • Hepatology
    • Infectious Diseases
    • Oncology
    • Neurology
    • Orthopedic Surgery
    • Pulmonology
    • Rheumatology
    • Urology
  • Patients
    • Patient Education
    • Question for Pharmacist
    • Refill a Prescription
    • Patient Portal/Registration
  • Providers
    • Rx Referral Forms
    • Sending Prescriptions
    • Consult a Pharmacist
    • Find Your Account Manager
    • Provider Portal
  • Referral Forms
  • Customer Survey
  • Portal

Send Prescriptions via E-Prescribe, Fax, or Phone


Simply download the form, type or print the appropriate information and fax to your local pharmacy.

We encourage you to e-prescribe to make the process easier. 
​
Contact your account manager for customized referral forms.

Please note: This section is for prescribing practitioners only. Patients must bring an original prescription to the pharmacy, and cannot fax these referral forms to Quality Specialty Pharmacy. Faxed prescriptions will only be accepted from a prescribing practitioner.

For best results, download the latest version of Acrobat Reader.
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Dermatology

Northeast
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Gastroenterology

Northeast
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General

Northeast
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Hepatology

Northeast
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HIV/AIDS

Northeast
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Lovenox

Northeast
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Neurology

Northeast
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Oncology 
(Oral and Injectible)

Northeast
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Orthopedic Surgery

Northeast
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Pulmonology

Northeast
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Rheumatology

Northeast
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Urology

Northeast
Don't see your specialty or medication?
We accept all prescriptions, feel free to ePrescribe or fax a General Prescription form for any medication you need filled for your patients.

Or call in the prescription to your local Quality Specialty Pharmacy. 

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  • Home
  • About
    • Locations >
      • Northeast
    • List of Services
    • About us
    • Copay Assistance
    • Frequently Asked Questions
    • Contact Us
  • Specialties
    • Dermatology
    • Gastroenterology
    • General
    • Hepatology
    • Infectious Diseases
    • Oncology
    • Neurology
    • Orthopedic Surgery
    • Pulmonology
    • Rheumatology
    • Urology
  • Patients
    • Patient Education
    • Question for Pharmacist
    • Refill a Prescription
    • Patient Portal/Registration
  • Providers
    • Rx Referral Forms
    • Sending Prescriptions
    • Consult a Pharmacist
    • Find Your Account Manager
    • Provider Portal
  • Referral Forms
  • Customer Survey
  • Portal
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