Download our NEW PATIENT ENROLLMENT FORM

Our Pharmacists AND Patient Care Coordinators are ready to provide the support and services you need to manage your health condition. We offer you:

• Reliable access to your specialty medications
• Free, express delivery to the location of your choice
• Free supplies for injectable medications, such as syringes, needles, alcohol wipes and a sharps container
• Free Medical Therapy Management
• We match competitors pricing
• Easy-to-understand educational resources
• Insurance billing and coordination of benefits
• Quick and easy refills by phone, fax, mail or online
• Free in home pharmacist consultations by appointment

*if patient resides within the home delivery zone.

Getting started with VascuScript Pharmacy

• Please complete all sections of this enrollment form. In accordance with VascuScript policies and HIPAA regulations, the information you provide is kept confidential.
• Provide prescription information by fax or mail:
• Ask your physician to fax your prescription to VascuScript Pharmacy at (716) 681.2270 Sorry, we cannot accept prescriptions faxed by patients.
• Mail the ORIGINAL prescription (photo copies cannot be accepted) to VascuScript Pharmacy, 2470 Walden Avenue, Suite 2400 Cheektowaga, New York 14225
• Do you have questions about VascuScript Pharmacy? Read answers to Frequently Asked Questions or call us at (716) 681.2968 option 2. Our Customer Care Team is available
  Monday through Friday, 8:00 a.m. to 7:00 p.m.; Saturday, 9:00 a.m. to 2:00 p.m.; Sunday, Closed.

IMPORTANT: Do not use this form to request a prescription refill. Use the Vascuscript Online Refill form instead.

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