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Texas Medicaid and other State Health-Care Program providers can use this form to update the enrollment information on fileARISTADA INITIO® (aripiprazole lauroxil), in combination with oral aripiprazole, is indicated for the initiation of ARISTADA® (aripiprazole lauroxil) when used for the treatment of schizophrenia in adults. ARISTADA is indicated for the treatment of schizophrenia in adults. IMPORTANT SAFETY INFORMATION FOR ARISTADA INITIO AND ARISTADAwww.aristadacaresupport.com. enrollment form is complete and accurate to the best of my knowledge. I understand that ... Preferred Pharmacy name Phone # Fax # If Benefit Verification results specify a pharmacy other than preferred pharmacy, ... 02451, 1-844-464-7171. Withdrawal of this authorization will end my consent to further disclosures of ...setting; see www.aristadacaresupport.com for more information, including restrictions and eligibility requirements. 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