Drug Information Request Form

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Medicaid prescribers in Illinois can contact the UIC Drug Information Center with a specific drug information request. The clinical pharmacists will research and respond to your inquiry within 48 hours. You may call us at 1-833-925-0928, between 8:00 a.m. and 5:00 p.m. (CST) Monday through Friday, or complete the form below.

Name

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Provider type

Physician Nurse practitioner Physician assistant Other (please specify)

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Provider type - Other

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National Provider Identifier (NPI) number

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Practice site name

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Practice site zip code

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Phone number

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Email address

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Question

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Additional information you would like us to know to respond to your request

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How would you like to receive your response?

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If you would like a phone response, what is the best time to call?

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