The Chickasaw Nation Employees Prescription Program

To avoid any delays, please refrain from sending any prescription requests until you have received approval of your application. Additionally, we kindly ask that you wait at least four business days after submitting your application before making any prescription requests.

Employees of the Chickasaw Nation can apply online or by sending all completed forms and required documentation to the Chickasaw Nation Refill Center.

Download, complete and return the form to the Chickasaw Nation Refill Center to verify eligibility for the program.

The Notice of Privacy Practices for the Chickasaw Nation Refill Center is a printable advisory for patients that explains the terms of use of patient-protected health information. This form is intended for patient use only and does not need to be returned to the pharmacy.

The Acknowledgement of Receipt of Notice of Privacy Practices Form must be signed and sent to the Chickasaw Nation Refill Center to be considered eligible to receive medications.

All participants must submit copies of the following documentation:

• Certificate of Degree of Indian Blood (CDIB) (if applicable)
• Tribal citizenship card (if applicable)
• Prescription insurance card, front and back
• Secondary prescription insurance card, front and back (if applicable)
• DL/state ID (Participants under 18 years of age need to have a parent or legal guardian’s valid ID on file)

Once your application is approved, submit your prescriptions to the Chickasaw Nation Refill Center for processing. Approved medications are provided to patients at no cost. When it’s time to refill your medications, you may use any of the convenient options listed below:

• Web Refill Patient Portal
• RefillPro smartphone application (iOS/Android)
• Call the pharmacy toll-free at 1 (855) 478-8725

Chickasaw Nation employees and dependents currently enrolled on the Chickasaw Nation Tribal Employee Medical/Rx Insurance Plan (CN WebTPA/Cerpass Rx) are eligible for the prescription program. All program participants require approval before receiving prescription assistance and requesting medications through the Chickasaw Nation Refill Center.