Pharmacy providers - Provider registration/update
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 firstname.lastname@example.org, or by calling our toll-free number 1-844-498-8292.
New provider registration
Location of pharmacy:
Manitoba and East
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 email@example.com.
Please note that it is not necessary to mail the original copy to our office.
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.
For updates to the legal name, please contact us by email firstname.lastname@example.org, or by calling our toll-free number 1-844-498-8292.