To receive a Trading Partner ID and logon information, please complete and return the ACS EDI Gateway enrollment packet for Pharmacy Benefits Management Commercial.

All submitters are required to complete the Pharmacy Benefits Management EDI Trading Partner Enrollment Form.

Enrollment Packet: The enrollment packet consists of two documents, which includes the EDI Enrollment Letter and Pharmacy Benefits Management EDI Trading Partner Enrollment Form.  To download these forms, please click on the document link below.
 

• North Carolina Seniors EDI Enrollment
• Pharmacy Benefits Management Trading Partner Agreement
   
• Hawaii EDI Enrollment
• Pharmacy Benefits Management Trading Partner Agreement

This document may be faxed to 850.201.1106 or mailed to the address below.

EDI Enrollment Department
2324 Killearn Center Boulevard
Tallahassee, Florida 32309
or Fax Form to 1-850-385-1705

If you have any questions regarding the ACS EDI Gateway Enrollment Packet, please call ACS EDI Gateway Support Unit at 1.800-672-4972,
Monday through Friday, 8:00 a.m. to 8:00 p.m. EST.