Provider Resources

Applying for a Patient

Providers, case managers, caregivers, patients, and patient advocates can apply on behalf of a patient. Applications can be received online or by telephone, fax, or mail. In doing so, it is necessary to obtain the following information:

• Basic Patient Info, including:




• Name


• Address


• Phone number


• Date of birth




• Patient insurance and prescription info


• Patient income information (household size and household income).

Pharmacy Providers

The Assistance Fund contracts with Alpha Scrip for Pharmacy Claims. You can submit claims electronically through your billing system, or by fax or mail using the contact information below. You will need the following information to submit a claim:

» Member Number: Can be found by using the lookup tool or by contacting the patient for their Member Card

» Group Number: Can be found by using the lookup tool or by contacting the patient for their Member Card

» RX BIN: 610600

» PCN: AS

» Processing Code: 08

Alpha Scrip
5080 N 40th St, Suite 339
Phoenix, AZ 85018
Phone: (877) 274-3244
Fax: (602) 840-9508

Site of Care Providers

For healthcare providers who are administering a prescription medication at their site, payments are facilitated through a claims administrator, Florida Health Administrators. You will need the following information to submit a claim:

» Member Number: Can be found by using the lookup tool or by contacting the patient for their Member Card

» Group Number: Can be found by using the lookup tool or by contacting the patient for their Member Card

» Payor ID: 86753

Florida Health Administrators
Payor ID 86753
P.O. Box 21426
Eagan, MN 55121
Phone: (866) 236-2673
Fax: (954) 901-2711