Utah Pharmacy Provider Portal - GHS eWebs

Registration

Welcome to the Utah Pharmacy Provider Portal Registration Page

By filling out this form, you are requesting access to the Utah Pharmacy Provider Portal

This information will be processed and verified. Please give us a couple of business days to finish processing your request

Required fields are marked by an asterisk (*).

User role . ( Changing the user role will modify the available fields in the form. Please review the form fields upon selecting a new role. )*:

Prefix:

First name*:

MI:

Last name*:

Postfix:

Title:

Date of Birth*:

Phone Number*:

Utah Medicaid Id*:

License Number*:

NPI*:

Email*:

Medicaid providers, business associates, contractors, or subcontractors who use this website are subject to the privacy and confidentiality laws set forth in the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH). By checking the acceptance box on this website, the user acknowledges and agrees to: (1) abide by the provisions of HIPAA and HITECH, (2) protect the data and information, and (3) utilize the data and information only for the minimum necessary use.

GHS Utah Pharmacy Provider Portal

Registration