Enrollment Checklist

  • Fully complete, sign and submit the Formula4Success enrollment form.
  • Make sure the prescription and letter of medical necessity for each Vitaflo product is signed by a MD and includes their National Provider Identifier number (NPI) and the patient’s diagnosis code.
  • Verify that the enrollment form is submitted within 30 days of the date listed on the prescription and letter of medical necessity.

If you have any questions about enrolling in the program, please do not hesitate to contact us.

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Please note that enrollments received between OCTOBER 1 st – DECEMBER 31st will be processed in January 2018.