Find the ICD10 code with the primary diagnosis/description listed below. Then click the associated link to open or download the PDF order form. Please follow the instructions on the form to submit the order to the CHOMP Pharmacy.

ICD Code


Order Form Link

K50.01 Crohn’s Disease Vedolizumab K50.01
K51.90 Ulcerative Colitis Vedolizumab K51.90