In order to enroll in the BCRx program:

• Click here to open printer friendly pop-up window containing application. 

• Complete and sign the application.

• Submit with a check for $19.99 payable to BCRx . 

• Fax or mail to BCRx:

Fax: (480) 947-0474
P.O. Box 1604
Scottsdale, AZ 85252-1604