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Pharmacy Network Application and Credentialing Request Pharmacy name/DBA name: CPDP #:NPI #:DEA #:Federal tax ID #:Exp. Date:Medicaid #:Pharmacy state license #:Exp. Date:Street address:County:City:State:Phone:Fax:ZIP
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01
Obtain the pharmacy network application form from the relevant authority or organization.
02
Fill out all the required fields on the application form accurately and completely.
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Provide any necessary supporting documentation or information requested.
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Ensure all information provided is up to date and relevant to the application.
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Review the completed application form for any errors or missing information before submitting.

Who needs pharmacy network application and?

01
Pharmacies looking to join a network of affiliated pharmacies.
02
Organizations or companies managing pharmacy networks.
03
Healthcare professionals or groups seeking to expand their pharmacy services.
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A pharmacy network application is a form submitted by pharmacies to become part of a pharmacy network, which allows them to provide services under a specific health plan or managed care organization.
Pharmacies that wish to participate in a pharmacy network associated with health plans or managed care organizations are required to file a pharmacy network application.
To fill out a pharmacy network application, pharmacies must provide required information such as business details, licensing information, and any agreements with the health plans or networks they wish to join, following the instructions provided by the specific network.
The purpose of the pharmacy network application is to evaluate pharmacies for eligibility and ensure they meet the standards and requirements set by the health plans or managed care organizations.
Information that must be reported includes the pharmacy's license details, ownership information, services provided, and any other relevant operational data as required by the network.
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