To register as a new provider, or update information for an existing provider, complete the applicable forms found below. If you have any questions or concerns regarding provider updates or registration, please contact us by email at email@example.com, or by calling our toll-free number 1-844-498-8292.
New provider registration
Location of pharmacy:
Please review the Guidelines to Pride RT. Complete the MB East registration form, then print and sign it.
The form can then be faxed to 780-498-3549; or scanned and emailed to firstname.lastname@example.org.
Please note that it is not necessary to mail the original copy to our office.Guidelines to Pride RT MB-East registration form
Existing provider update
For updates to the following information for existing providers, complete the Provider Information Change form:
- Operating name
- Site or mailing address
- Phone or fax number
For updates to banking information for existing providers, complete the Direct Deposit Authorization form.
Direct deposit authorization form