Registration Step 1:

Fill out the following form

Please fill out all fields. Once complete you must print, fill out, and return the KY Meds Check Draft Authorization Form.

If you would prefer to download the application and fax/email, please click here to download.

[contact-form-7 id="111"]

Registration Step 2:

Download, print, fill out, and return the KY Meds ACH Form via email to accounting@kymeds.com or fax to 877-683-2065

Fill out the ACH form and return it via email or fax: