Send in your pre-qualifying form today.
Pre-qualify Your Pharmacy Today
Click here to download our pre-membership form and checklist.
This form will be used to qualify you for the formal application process with
EPIC and the EPIC Pharmacy Network.
You can also email your request and we will fax or mail the form to you.
Upon Completion of Pre-qualification Form
You may fax your completed paperwork to us at 410-667-3786.
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