CastiaRx Online
Today is: Saturday, February 27, 2021
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To the best of my knowledge the information supplied in this request is true, accurate and complete and is hereby released to CastiaRx for the purpose of accessing the Network Pharmacy Resource on-line portal. I understand that falsification; omission, or misrepresentation of any information in this document will result in a denial of access to the portal, possible enrollment rejection or pharmacy corrective action and may be punishable by criminal, civil, or other administrative actions.

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Disclaimer: The information provided herein is confidential and proprietary and is considered “Confidential Information” as that term is defined in the Pharmacy Provider Manual (including but not limited to: MAC Prices, username(s), and password(s). Pursuant to the terms of the Pharmacy Provider Manual, you may not disclose, sell, assign, transfer, or give confidential information to any third party.
Pharmacy providers must comply with all applicable Laws regarding the submission of confidential information, including, without limitation, the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).