CBCA Rx Formulary

Provider Manual

 

Pharmacy Provider Procedures Manual

July 2001

CBCA Rx is committed to providing the best quality service possible. Please follow the information provided in this manual to ensure that submitted claims are processed in a timely manner.

CBCA Rx TOLL-FREE TELEPHONE NUMBER

1-800-383-8737

This number is your single contact for all Pharmacy Provider questions. This includes questions regarding:

Claim Status NDC Information
Point-of-Sale Problems   Co-Payment Questions
Eligibility Questions Pharmacy Enrollment Status
Benefit Coverages  

 

TABLE OF CONTENTS

Section 01:  CBCA Rx STANDARDS

Section 02:  SUBMISSION OF PRESCRIPTION CLAIMS

Section 03:  CBCA Rx IDENTIFICATION CARD

Section 04:  PRIOR AUTHORIZATIONS

Section 05:  COMPOUND PRESCRIPTIONS

Section 06:  CREDENTIALING

Section 07:  PHARMACY AUDIT REQUIREMENTS

Section 08:  COMPLAINT AND APPEALS PROCEDURE

Section 09:  WORKERS COMPENSATION

Section 10:  FREQUENTLY ASKED QUESTIONS

Section 11:  CBCA Rx PAYOR SHEET

Section 01:  CBCA Rx STANDARDS

  • Telephone calls from Provider Pharmacies into CBCA Rx’s Help Desk are answered with an average-speed-of-answer of 30 seconds or less.
  • CBCA Rx’s Pharmacy Services Help Desk will respond to 95% or greater Provider Pharmacy inquiries at the initial point of contact.
  • Pharmacy Services Help Desk Representatives are available 90 hours a week to provide assistance to pharmacies through our toll-free number.
  • In addition to a 4 week intense training program, CBCA Rx hires Pharmacy Technicians to assist with provider related issues.
  • For any willing provider, CBCA Rx will allow immediate claim processing. A 30 day window is established, during which a pharmacy contract is forwarded to the provider for review and response. Pharmacy eligibility is finalized within 48 hours of completed contract receipt.
  • Claims can be reversed up to 180 days from the date processed.

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Section 02:  SUBMISSION OF PRESCRIPTION CLAIMS

  • Pharmacies must submit claims through an on-line point-of-sale adjudication system within 30 days of dispense date.
  • Pharmacy Vendor and Point-of-Sale Devices:
  • Point-of-sale claims must be submitted to CBCA Rx through a pharmacy computer system or point-of-sale device. Please contact your pharmacy system or point-of-sale software vendor with any questions about how to submit point-of-sale claims.
  • Point-of-sale claims submitted to CBCA Rx must be transmitted through a communication network. All claims must be submitted in NCPDP Version 3.2 (3A) format unless otherwise stipulated by CBCA Rx.

  1. CBCA Rx will identity whether a claim has been accepted or rejected. If the claim is accepted, CBCA Rx’s claim processing system will identify the amount paid and the co-pay to be collected. Our claim processing system will provide additional informative messages when possible (e.g., the quantity allowed is less than submitted). If the claim is rejected, CBCA Rx’s claim processing system will identify the reason(s) for the rejection.

  2. All claims received at CBCA Rx by the last business day of the processing cycle will be processed in the current payment cycle. Checks will generally be disbursed within three weeks of processing and will be mailed to the pharmacy by CBCA Rx.

  3. PCN (Processor Control Number)

    When submitting claims through point-of-sale, the pharmacy is not required to submit a Processor Control Number. Your switch may require one.

  4. BIN Number

    When submitting claims through point-of-sale, the pharmacy is required to submit a BIN number (Bank Identification Number) to route the claim properly to the CBCA Rx Claim Processing System. The BIN number for CBCA Rx is 006160. Your pharmacy service department or software vendor will need this number to properly submit claims to CBCA Rx.

  5. Reversals

    If a claim previously accepted through point-of-sale must be resubmitted, the pharmacy must first submit a reversal. A reversal should also be submitted when a member fails to pick up a filled prescription. There is no time limit for the submission of reversals.

  6. Compounds

    CBCA Rx will be establishing enhanced guidelines for compounding. Until the credentialing requirements are in place, any store submitting a claim for compounds will be remunerated according to the following standards:

    All claims for compounded prescriptions that contain a legend ingredient can be sent to CBCA Rx through the on-line system. Use the NDC number of the most expensive legend drug when submitting a compounded prescription claim. Indicate through your software that the prescription is a compound through the use of the compound code. The NDC numbers, medication names and quantities of the individual ingredients in the prescription must be maintained in the pharmacy's records and the pharmacy may be subject to audit of these compounded prescriptions.

  7. Prescription Log

    The pharmacy shall have the member sign a prescription log for all CBCA Rx prescriptions dispensed.

  8. DEA Number

    CBCA Rx uses the DEA number as part of its drug utilization management programs. To provide the best quality service to our Clients, CBCA Rx requires that pharmacies input the DEA number on all submitted claims. CBCA Rx plans to utilize another standard physician identifier as soon as a new industry standard is available.

  9. The pharmacy provider is expected to substitute generic drug products when appropriate and within the state laws and regulations.

  10. The pharmacy provider is required to submit an accurate Dispense as Written (DAW) code.

  11. The pharmacy provider is expected to display all Drug Utilization Review (DUR) alerts to the dispensing pharmacist.

  12. The pharmacy provider is expected to facilitate member counseling regarding medication use, storage, and potential adverse effects.s

  13. The pharmacy provider is expected to notify CBCA Rx within 48 hours of any change regarding the pharmacy or pharmacists license.

Troubleshooting

If the pharmacy system or point-of-sale software is unable to make a connection with the CBCA Rx claims processing system, the pharmacy should contact the communication network vendor (or chain headquarters if the pharmacy chain has a direct line to CBCA Rx). If no problem is found through the efforts of the communication network, please contact CBCA Rx at 1-800-383-8737.

If clarification is desired for reasons provided for a claim rejection, contact CBCA Rx at 1-800-383-8737. Please have your pharmacy's NABP number and prescription number available, as well as the member’s ID number when calling. This telephone number should be used for any questions related to pharmacy, prescriber, or member eligibility.

Adjustments

Through internal quality control procedures, a pharmacy may discover it has been incorrectly paid for a prescription. The prescription may have been filled but not picked up by the member, or an inadvertent billing error may have been made. DO NOT send a refund check to CBCA Rx. Please notify CBCA Rx of the overpayment and an adjustment will be made to a future pharmacy check for the amount in question. CBCA Rx will need the following information to make the adjustment:

* Pharmacy NABP #

* Member Name and Date

* Dispense Date

* RX number or NDC Number

In summary, when an overpayment is discovered by the pharmacy, contact CBCA Rx at 800-383-8737.

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Section 03:  CBCA Rx IDENTIFICATION CARD

CBCA Rx has many clients and several different eligibility cards. Below is a sample card:

Members of most plans are provided with a Membership Identification card. Each family member may be listed on the card, each family member may be issued his or her own card, or only the cardholder's name may appear on the card.

When filing a claim for services, it is important to see the ID card and the name of the member who will be using the prescription. The presentation of an ID card does not guarantee eligibility for a prescription benefit. Eligibility can only be determined through the on-line adjudication process or by approval from CBCA Rx or CBCA Rx's representative.

For cards with multiple service logos and information, please note the above logo to represent CBCA Rx pharmacy services.

These are some of the fields that generally appear on the card to help the pharmacist identify the plan and the member.

GROUP NUMBER: An EIGHT-digit number designated by the Plan Sponsor or CBCA Rx MUST be submitted by the pharmacy.

CARDHOLDER ID NUMBER: (The subscriber identification number). The cardholder ID number may be followed by a two-digit suffix. This suffix should be included when submitting claim information.

CARDHOLDER NAME: The subscriber name associated with the cardholder ID number.

COPAY: Please refer to the Specific Plan Sponsor Information.

If unable to process the claim electronically, please call the Help Desk at 1-800-383-8737 to ascertain eligibility. Ensuring that the member receives their prescription efficiently is a primary concern of CBCA Rx.

WORKER’S COMPENSATION PROGRAM: Please refer to the Worker’s Compensation Section of this Manual.

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Section 04:  PRIOR AUTHORIZATIONS

At the request of some Sponsors, certain medications or classes of medications will require additional information to be obtained to determine if the benefit is covered.

Claim Message on Prior Authorization

The following components on the claim message indicate that a prior authorization is needed: "75" with message "Prior Authorization Required."

Please advise the member of the need for a Prior Authorization and facilitate the process by contacting the CBCA Rx helpdesk at 1-800-383-8737. If this is not possible, please refer the member to CBCA Rx’s helpdesk at 1-800-383-8737.

Final decisions will be communicated to the member. At the member’s request and under specific arrangements, the pharmacy will be notified directly.

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Section 05:  COMPOUND PRESCRIPTIONS

Definition of a Compounded Prescription

A compounded prescription is one which meets the following criteria: Two or more solid, semi solid or liquid ingredients, one of which is a "Prescription Legend Drug", that is either weighed or measured then prepared according to the prescriber's order and the Pharmacist's art.

Procedures for Submitting Compound Prescription Claims:

  1. Set the "Compound Flag" to positive in accordance with the Pharmacy Software.
  2. Submit the NDC number for the highest priced Federal Legend Drug.
  3. Enter the metric quantity as the total amount of the finished product.
  4. Enter the total cost of all ingredients, the professional fee and your "usual and customary" price.
  5. Enter patient and group information as you would any other claim.
  6. Collect from the cardholder only the applicable Copayment/Coinsurance as indicated.

For Compounded Prescriptions or Bulk Chemicals where no NDC is available the following procedures are to apply:

Call the Pharmacy Services Help Desk (1-800-383-8737).

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Section 06:  CREDENTIALING

Credentialing/Re-credentialing/Performance Standards

The credentialing standards and performance standards of belonging to CBCA Pharmacy Benefit Management’s network include, without limitation:

  1. Completion of the Participating Provider Application
  2. Pharmacy shall fill prescriptions according to the Prescriber’s directions.
  3. Pharmacy will maintain patient profiles for prescription medication dispensed from Pharmacy.
  4. Pharmacy will react promptly and appropriately to on-line edits, which may adversely affect the patient's medical status or coverage.
  5. Pharmacy will provide instruction to the patient on use of medications including information provided via on-line drug messages prior to dispensing any prescription.
  6. Pharmacy shall maintain established prescription error prevention measures and established process for handling prescription errors.
  7. Pharmacy shall require each person requesting Covered Drug and Services to present an identification card and/or other forms of identification as specified from time to time by CBCA Pharmacy Benefit Management.
  8. Pharmacy shall maintain a signature log at each Pharmacy location and require any Member who receives a Covered Service (or such Member's representative) to sign the log.
  9. Pharmacy shall comply with the MAC List in dispensing a Covered Drug, unless Pharmacy is (a) otherwise directed by a Prescriber via a valid prescription order or refill; (b) prohibited from so complying by law; (c) otherwise directed by CBCA Rx; (d) Professional judgment.

EXHIBIT A

    CBCA Rx PARTICIPATING PHARMACY PROVIDER APPLICATION

    This document must be completed for all store locations of your Pharmacy.

    General

    Company Name _______________________
    Street Address ________________________
    Federal Tax ID #_______________________
    State Pharmacy Operating License #________
    Pharmacy System______________________
    System Distributors License_______________
    Pharmacy Name ______________________
    City ______________State ____Zip______
    NABP #___________________________
    Fax # _____________________________
    Telephone__________________________
    Contact Person at Pharmacy_____________

    Services

    1. What are your pharmacy hours of operation?

      2. Monday_________ Tuesday________ Wednesday_________ Thursday_______
      Friday__________ Saturday________ Sunday___________

    2. Does your pharmacy offer a delivery service? Yes_____ No _____
    3. Does your pharmacy offer 24-hour emergency service? Yes _____ No_____
    4. Does your pharmacy provide compounding? Yes _____ No _____
    5. Do your employees have multilingual capabilities? Yes _____ No_____
    6. Does your pharmacy system support multilingual patient information needs? Yes___No___
    7. What other special service does your pharmacy offer?

    License and Related Information

    1. Does your pharmacy have a valid DEA registration Number?   Yes____ No____
    2. Has your DEA number ever been suspended or revoked?   Yes____ No____
    3. Has the Pharmacy, any pharmacist employed or its officers ever been convicted of a felony?   Yes____ No____
    4. Has any individual provider been suspended or terminated from Medicare or Medicaid programs in any state?   Yes____ No____
    5. Does any individual provider have any impairment due to chemical dependency/drug abuse?   Yes____ No____
    6. Does any individual provider have past or pending professional disciplinary actions, sanctions, or licensure limitations in the state in which the pharmacy operates?   Yes____ No____
    7. Has an out-of-court settlement or a judgment been paid concerning a professional liability claim on behalf of your pharmacy by any malpractice carrier?   Yes____ No____
    8. Please provide the following:
      • A copy of the Pharmacy’s valid State Pharmacy Operating License;
      • Proof of valid professional liability and general liability insurance in the amounts of $1 million per occurrence and $ 2 million aggregate coverage;
      • A copy of a valid DEA registration;
      • A copy of each Pharmacy’s NABP number;
      • A completed Participating Pharmacy Provider Application;
      • A copy of any pharmacist license which has restrictions;
      • A copy of the patient information leaflet you provide Members with each prescription.

    Please explain "yes" answers to any of questions 2 – 7 on attached sheet.

    Labeling

    Place a sample label used when filling prescriptions here:

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Section 07:  PHARMACY AUDIT REQUIREMENTS

As the prescription drug benefits manager for various customers, CBCA Rx has an obligation to ensure all contracted services are being provided. Compliance with the Participating Pharmacy Agreement is critical. CBCA Rx or its designates will perform pharmacy audit functions to ensure program integrity.

Audit Considerations:

  1. Audits may encompass prescriptions processed up to 36 months prior unless otherwise legally required.
  2. Hard copy prescriptions must be readily available upon request.
  3. All prescriptions must contain complete documentation of items and quantities dispensed including insulin and syringes.
  4. Hard copies must be updated yearly unless otherwise stipulated by state law.
  5. A signature log must be maintained for all claims submitted. The patient or Authorized representative must sign the log for each prescription received.
  6. Signature logs must be maintained for the same length of time required to maintain prescription hard copies. The logs must be readily available for audit.
  7. If the plan authorizes the use of a Universal Claim Form, this form must have the cardholder's signature on the tissue copy.
  8. The quantity to be dispensed must be entered exactly as written on the prescription. Adjustments to meet plan parameters or legal requirements are permitted.
  9. The days supply must be entered exactly as written on the prescription, if the physician has included this information.
  10. Subsequent changes to the prescription by the prescriber must be noted on the prescription.
  11. Dispense as Written (DAW) codes must be used correctly. Follow-up documentation resulting from the Audit is not permitted.

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Section 08:  COMPLAINT AND APPEALS PROCEDURE

CBCA Rx maintains two separate procedures for resolving complaints and formal grievances. While CBCA Rx prefers to resolve complaints in an informal fashion, it recognizes that occasionally a matter may not be resolved to the satisfaction of a member or Provider. If that happens, the following are the steps to take:

Complaints

A) Denial of Urgent Services - This procedure is to be used:

1) If a member has been denied needed, medically necessary and potentially covered services AND 2) You or the Member believes that serious medical consequences will arise in the near future (within 7 - 10 days) on the basis of that denial.

You (or the Member) should call Provider Relations and explain the problem. CBCA Rx, or its agents, will collect the relevant information from you and any other providers. CBCA Rx will then review the matter. You and the Member will be notified in writing of CBCA Rx's decision within five (5) business days of the receipt of all the information necessary to decide the issue, whichever is earliest.

B) Other Complaints

Every Member and every Provider may use this process to resolve other types of complaints that have not been resolved informally. For a Provider, this process is not appropriate for use in credentialing and re-credentialing matters. The procedure as described in this section is appropriate to use for the following types of problems (the following is not an exhaustive list):

  1. The patient will not follow medical instructions, and the Provider wishes to terminate a relationship with the patient;
  2. The Provider is unable to obtain records from another Provider necessary to perform services;
  3. The Provider is not receiving the reimbursement he/she believes is required;
  4. The Provider has experienced difficulties obtaining required information from CBCA Rx or its agents;
  5. CBCA Rx has denied prior approval for what the Provider or patient believes to be an indicated, but not emergency, service or referral.

These complaints should be made by calling or writing the CBCA Rx Provider Relations (or Member Services) Department. CBCA Rx will investigate and a determination will be reached within five (5) working days. This decision will be communicated to you in writing within five (5) working days after that.

If you or the patient is not satisfied with the resolution of issues raised in this way, you may appeal using the formal appeals process.

Formal Appeals Procedure

This Appeals Procedure is to be used after efforts to resolve a problem informally, and then through the above procedures, have not been successful in resolving the concern to the satisfaction of the Member of the Provider. An appeal should be made within 120 days after the discovery of the problem leading to the complaint.
    1. An appeal must be requested in writing to CBCA Rx, Attn.: Prescription Benefit Management, 675 Foxon Road, Suite 204, East Haven, CT 06513. The letter should contain a statement of the problem, an explanation of why the earlier efforts at resolution were not satisfactory, and a statement of and rationale for the outcome you are seeking.
    2. Your appeal will be presented to a Committee established by CBCA Rx. If you wish to appear before the Committee in person, please include that request in the letter of appeal; CBCA Rx will then notify you of the date and time during which the Committee will consider the appeal.
    3. If the appeal concerns a denial of urgent services, the Committee will decide your appeal within three (3) business days of the receipt of the appeal. CBCA Rx will then notify you immediately in writing of its decision. Otherwise, the Committee will decide the appeal within fifteen (15) business days of the receipt by CBCA Rx of the appeal. CBCA Rx will notify you in writing of its decision, and the reasons for it, within five (5) business days of the decision. This letter will also describe further appeal rights.
    4. In all cases, unless otherwise determined by law, all final appeals will be held with CBCA Rx’s client. This reflects CBCA Rx’s client ultimately of establishing and interpreting plan rules.

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Section 09:  WORKERS COMPENSATION

Workers Compensation claims are processed on-line as other claims.

For new injuries, claimants with established claims will present a card. The prescription will have a sticker on the back. This is the compensation guarantee of payment and provides on-line billing information. For assistance, contact the Help Desk at 800-383-8737.

Coverage for Workers Compensation is determined by the outcome of the injury claim. Coverage may be indefinite or as short as a few weeks.

Each injury claim is assigned an appropriate drug class coverage. This may not always meet the Claimant’s needs. Please contact CBCA Rx at 1-800-383-8737 or refer the claimant to CBCA Rx.

In the event that the claimant and the medical provider designate a drug as related to the nature of the injury, verbal approval, from sources other than CBCA Rx, does not guarantee payment.

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Section 10:  FREQUENTLY ASKED QUESTIONS

Q. What is CBCA Rx’s BIN number?

A. The BIN number for all CBCA Rx Plans is 006160.

Q. What is CBCA Rx’s processor control code?

A. CBCA Rx does not require an access code to process claims; however, the switch or the chain headquarters might require these to process.

Q. What is my pharmacy’s access code for CBCA Rx to process claims electronically?

A. The CBCA Rx HelpDesk Associates do have an abbreviated list of chain access codes. If you are contracted and do not know your pharmacy’s access code, you can contact the CBCA Rx HelpDesk or your software vendor for assistance.

Q. Is my pharmacy a Contracted Pharmacy?

A. Many independent pharmacies are contracted with CBCA Rx, but may not realize they are in our network. This may occur when that pharmacy is a member of an organization that is contracted with CBCA Rx. For any non-participating pharmacy, upon contract, CBCA Rx will facilitate an immediate 30-day processing opportunity. A contract will be forwarded the following business day. Each pharmacy that receives a newsletter has had claims processed through CBCA Rx.

Q. What is the correct relationship code for this member?

A. Relationship code refers to the cardholder, spouse, and dependent. It is independent of the person code; e.g., all dependents may have the same relationship code.

Q. What is the correct person code for a family member?

A. Person Codes for family members usually follow a set pattern: Cardholder is always "01"; Spouse is always "02"; dependents are numbered "03" to "99". Usually, the dependents are numbered according to the age of the dependent. The oldest dependent will start at "03". The person codes assigned to the dependents within a specific family are not reassigned when an older child is no longer a dependent as defined by the plan parameters.

Q. What does "Invalid Date of Birth" message mean if the correct date of birth has been submitted?

A. Always check the relationship code submitted. A cardholder must be entered as such and submitted as a cardholder. Relationship coding is primary in checking appropriate eligibility. If a provider software has multiple linking requirements, oversight of the multiple links may lead to submission of incorrect data.

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Section 11:  CBCA Rx PAYOR SHEET

CBCA Rx

Date: 03/01/2001
Bin #: 006160
States: National
Destination: HealthTrans
Accepting: Claim Adjudication, Claim Reversals, and DUR Format

NCPDP Version 32 (Variable)(also accept 3A)

1. NCPDP Data Elements Version 32 Variable


Fld # Data Element Format Description
       
Required Header Information

101-A1

Bin # NCPDP Required, 006160
102-A2 Version # NCPDP Required
103-A3 Transaction Code NCPDP Required

104-A4

Processor Control # NCPDP Optional
201-B1

Pharmacy #

NCPDP Required

301-C1

Group # NCPDP Required
302-C2 Cardholder ID # NCPDP

Required
303-C3 Person Code NCPDP Optional
304-C4 Date of Birth NCPDP Required
305-C5 Sex Code NCPDP Required
306-C6 Relationship Code NCPDP

Required
308-C8 Other Coverage Code NCPDP Optional (required if applicable to claim)
401-D1 Date Filled NCPDP

Required
Optional Header Information
307-C7 Customer Location NCPDP Optional
309-C9 Elig Clarif. Code NCPDP Optional
310-CA Patient First Name NCPDP Required
311-CB Patient Last Name NCPDP Required
314-CE Home Plan NCPDP Optional
315-CF Employer Name NCPDP Optional
316-CG Employer Street Address NCPDP N/A
317-CH Employer City Address NCPDP N/A
318-CI Employer State NCPDP Optional
319-CJ Employer Zip Code NCPDP Optional
320-CK Employer Phone # NCPDP Optional
322-CM Patient Street Address NCPDP Optional
323-CN Patient City Address NCPDP Optional
324-CO Patient State Address NCPDP Optional
325-CP Patient Zip Code NCPDP Optional
327-CR Carrier Id# NCPDP Optional
329-CT Patient SSN NCPDP Optional

Required Claim Information
402-D2 RX # NCPDP Required
403-D3 New/Refill Code NCPDP Required
404-D4 Metric Quantity NCPDP Required
405-D5 Days Supply NCPDP Required
406-D6 Compound Code NCPDP Required
407-D7 NDC # NCPDP Required
408-D8 Disp. as Written NCPDP NCPDP Optional (required if applicable to claim)
409-D9 Ingredient Cost NCPDP Required
411-DB Prescriber ID NCPDP Required
414-DE Date Written NCPDP Required
415-DF # Refills Auth. NCPDP Required
419-DJ Prescr.Origin Code NCPDP Optional
420-DK Prescr. Denial Clar. NCPDP Optional
426-DQ Usual & Cust. Charge NCPDP Required

Optional Claim Information
410-DA Sales Tax NCPDP Required(required if applicable to claim)
412-DC Disp. Fee Submitted NCPDP Required
416-DG PA/MC Code & Number NCPDP Optional(required if applicable to claim)
418-DI Level of Service NCPDP Required
421-DL Primary Prescriber NCPDP Optional
422-DM Clinic ID NCPDP Optional
423-DN Basis of Cost Deter. NCPDP Required
424-DO Diagnosis Code NCPDP Optional
427-DR Prescriber Last Name NCPDP Optional
428-DS Postage Amt. Claimed NCPDP Optional
429-DT Unit Dose Indicator NCPDP Optional
430-DU Gross Amount Due NCPDP Required
431-DV Other Payor Amount NCPDP Required (required if applicable to claim)
432-DW Basis of Days Supply Deter. NCPDP Required
433-DX Patient Paid Amount NCPDP Optional
434-DY Date of Injury NCPDP Optional
435-DZ Claim/Ref. ID# NCPDP Optional
436-E1 Alt. Product Type NCPDP Optional
437-E2 Alt. Product Code NCPDP Optional
438-E3 Incentive Amt. Subm. NCPDP Optional
439-E4 DUR Conflict Code NCPDP Optional
440-E5 DUR Intervention Code NCPDP Optional
441-E6 DUR Outcome Code NCPDP Optional
442-E7 Metric Decimal Qty. NCPDP Required
443-E8 Prim. Payor Denial Date NCPDP Optional

 

An "optional" element means the user should be prompted for the field but does not have to enter a value, unless that field is required for special processing. For example, if you are submitting COB information as the secondary claim, Other Payor Amount and Other Coverage Code would be required.

2. General Information

Live Claims, on or after: March 16, 2001

Maximum prescription per transaction: 3

Payor/Plan Help#: 1 (800) 383-8737

Vendor Re-Certification Required: No

Pharmacy Reg. with Payor Required: Yes

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