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Este acuerdo establece la relación entre Pharmacy Providers of the Southeast, LLC y las farmacias participantes que aceptan dispensar recetas a los miembros de planes de beneficios administrados
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How to fill out participating pharmacy agreement

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How to fill out Participating Pharmacy Agreement

01
Obtain the Participating Pharmacy Agreement form from the relevant organization or website.
02
Read the instructions carefully before filling out the form.
03
Fill out the pharmacy's name, address, and contact information in the designated fields.
04
Provide the pharmacy's National Provider Identifier (NPI) number, if applicable.
05
Include any required certifications or licenses as specified in the agreement.
06
Sign and date the application where indicated.
07
Submit the completed form to the organization offering the agreement, following their submission guidelines.

Who needs Participating Pharmacy Agreement?

01
Pharmacies that want to participate in a specific network or health plan.
02
Pharmacies looking to provide services covered by a given insurance provider.
03
Pharmacies aiming to increase patient access and reimbursement opportunities.
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Participating Pharmacy means a pharmacy that has entered into a prescription drug plan agreement with the Pharmacy Benefit Manager listed on your identification card.
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These agreements, utilized by pharmacies under common ownership and pursuant to a contract between pharmacies that are not under common ownership, enable pharmacies to work with each other to perform certain prescription dispensing tasks.

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A Participating Pharmacy Agreement is a contract between a pharmacy and a pharmacy benefit manager (PBM) or a health plan, which allows the pharmacy to provide medication to members of that health plan or PBM under specific terms and conditions.
Pharmacies that wish to participate in a pharmacy network offered by a pharmacy benefit manager or health plan are required to file a Participating Pharmacy Agreement.
To fill out a Participating Pharmacy Agreement, a pharmacy must provide required information such as the pharmacy's name, address, contact information, and applicable state licenses, and sign the agreement as specified by the PBM or health plan.
The purpose of a Participating Pharmacy Agreement is to establish the terms under which the pharmacy will provide covered medications to members of the health plan or PBM, ensuring compliance, reimbursement protocols, and access to benefits for patients.
Required information on a Participating Pharmacy Agreement typically includes the pharmacy's legal name, address, National Provider Identifier (NPI), Medicaid/Medicare enrollment details, licensing information, and the signature of an authorized representative.
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