Surescripts Application Certification Requirements Request

Surescripts Application Certification Requirements Request

Please complete the "Surescripts Application Certification Requirements Request" for any Additions, Revisions, or Deletions you would like to propose to the existing Surescripts Formulary, Benefit & Eligibility Application Certification Requirements. All fields must be completed in order for the proposed requests to be submitted through the Surescripts ACRG process. Please contact ACRG@Surescripts.com if you have questions.