Information Request

If you would like to learn more about WisconsinRx / National CooperativeRx, please complete the brief questionnaire below. One of our staff will contact you.

Company Name *
Address Line 1 *
Address Line 2
City *
State *
Zip *
Contact Name *
Title
Telephone (example 123-456-7890)
Extension
Fax (example 123-456-7890)
Email Address *
Are you? self-funded fully insured
Current insurance company, HMO, or network
Total Employees
Current Pharmacy Benefit Manager (PBM) and Third Party Administrator (TPA)
Current plan renewal date (mm/dd/yyyy)
Earliest anticipated date able to change PBMs (mm/dd/yyyy)

If you do not want to submit this form, please contact us in any of the following ways:

Email us: info@wisconsinrx.com

Call us: (608) 204-9479
Toll Free: 866-679-9479
Fax us: (608) 204-9480

Mail us:
WisconsinRx / National CooperativeRx
195 East Badger Rd.
Madison, WI 53713

What They're Saying

"Being part of a pharmaceutical alliance is appealing because it gives a smaller employer the kind of purchasing clout you can only get by being part of a larger coalition. We have seen a dramatic impact."

-Debbie Hayden, Director/Human Resources, Eau Claire, WI Press Company