abbvie Account Update Request Form for Existing Customers Instructions
- June 13, 2024
- abbvie
Table of Contents
abbvie Account Update Request Form for Existing Customers Instructions
INSTRUCTIONS
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Select a Request Type and complete all fields.
-
Save the completed PDF including your Request Type and Account Number in the file name.
Example: Ownership Change – Account 1234567 -
Email the completed form to IR-[email protected], including your Request Type and Account Number in the subject line.
Example: Address Change – Account 1234567
Important Note: If multiple account updates are required, kindly submit a separate PDF form and email for each Request Type.
REQUEST TYPE (Click to select one)
- Shipping Address Change
- Add New Shipping Location
- Business Name Change
- Ownership Change
- Account Reactivation
- Medical Director Change
- Contact Information Update
CONTACT INFO
Contact Person First/Last Name:_
Contact Person Title:___
Contact Person Phone:_____
Contact Person Email:____
- Billing Address Also Changing? Select
- Shipping Account Number:
- New Ship-To Address:
- New Ship-To Facility Name (for c/o):
- Business Phone Number:
- Medical Director Name:
- Medical Director State License Number:
- Medical Director Email:
OHIO ONLY
Is the practice headquartered in Ohio?
Yes
No
Credentialing will follow-up
Documents / Resources
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abbvie Account Update Request Form for Existing
Customers
[pdf] Instructions
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Existing Customers, Request Form for Existing Customers, Form for Existing
Customers, Existing Customers, Customers
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