Mail Order Forms
Members who wish to enroll in Exactus Pharmacy Solutions can enroll online or complete our enrollment form to register with the program. Once your patients are enrolled, doctors can submit prescriptions by filling out an Exactus Pharmacy Solutions Prescription Order Form.
Please fax completed forms to 1-866-892-8194 or mail to us directly at:
Exactus Pharmacy Solutions™
PO BOX 31422
Tampa, FL 33631-3422
You can also call us at 1-877-232-0930 (TTY 1-866-507-6135), 24 hours a day, seven days a week.