Maternity Supplies Prescription Form

Fill out the form below, so we can ensure your patients get what they need.

For Providers

Submit a prescription

Use the secure form below to send us prescription and referral details. Our team reviews every submission and follows up with your office if additional documentation is needed.

By submitting this form you confirm that the information provided is accurate. Ardent Medical Supply will contact your office if additional details are needed.

Coverage

Insurance plans we are partnered with

Your patient's plan may be listed below. Search by carrier, state, or plan type — our team verifies specific coverage before every order.

Aetna

  • N/A N/A — AARP
  • NJ NJ — Commercial
  • NY NY — Commercial

Amerigroup

  • NJ NJ — Commercial
  • NY NY — Commercial Medicaid

AmidaCare

  • NY NY — Medicaid

Centivo

  • NY & NJ NY & NJ — Commercial

Empire BCBS Healthplus

  • NY NY — Medicaid

Fidelis Care

  • NY NY — Medicaid
  • NY NY — Essential

GHI

  • NY NY — Commercial

Hamaspik

  • NY NY — Medicaid

Health Care Partners

  • NY NY — Commercial
  • NY NY — Medicaid

Healthfirst

  • NY NY — Commercial
  • NY NY — Essential
  • NY NY — Medicaid
  • NY NY — Medicare

Highmark BCBS Western New York

  • NY NY — Medicaid

HIP

  • NY NY — Commercial
  • NY NY — Medicaid

Independent Health of New York

  • NY NY — Commercial Medicaid
  • NY NY — Exchange

Local 1199 National Benefit Fund

  • NY NY — Commercial

Medicaid

  • NY NY — Standard Medicaid

MetroPlus

  • NY NY — Commercial
  • NY NY — Essential
  • NY NY — Medicaid

Molina Affinity

  • NY NY — CHIP (Affinity)
  • NY NY — Commercial
  • NY NY — Medicaid (Affinity)

Multi-Plan

  • NY NY — Commercial

Neighborhood

  • RI RI — Commercial

Oscar

  • NY NY — Commercial

Qualcare

  • NJ NJ — Commercial

Qualcare - Oscar

  • NY NY — Commercial

SOMOS - Anthem

  • NY NY — Exchange
  • NY NY — Medicaid

SOMOS - Emblem

  • NY NY — Exchange
  • NY NY — Medicaid

Tri Care Humana

  • All States All States — Military (East)

United HealthCare

  • NY NY — Commercial
  • NY NY — Medicaid
  • NY NY — Medicare

WellCare

  • NY NY — Medicaid

Questions about a referral?

Our provider services team can walk you through documentation requirements, coverage questions, and turnaround times.

Call Ardent Medical Supply at 347-425-1334.