|
|
 |
NIHB Pharmacy Provider Documentation
Registration
Instructions
To register in the Pharmacy NIHB Program:
| 1. |
Download the Pharmacy Provider Agreement:
 Pharmacy Provider Agreement
Sample Copy of a completed Pharmacy Provider Agreement:
Pharmacy Provider Agreement (Completed Sample)
|
| 2. |
Complete the Pharmacy Provider Agreement fully for all required sections. |
| | Did you know… |
| | Electronic Funds Transfer (EFT) is free and secure? |
| |
Sign up by completing the Payment Information section on the Pharmacy Provider Agreement and eliminate mail delivery delays of lost, misplaced, or stolen cheques! Receive your claim payments directly into your designated bank account on the day the payment is issued and still continue to receive mailed statements for reconciliation! |
| 3. |
Sign the Pharmacy Provider Agreement (where indicated). |
| 4. |
Fax all pages (including a photo copy of a VOID cheque or official bank letter for EFT payments) of the Pharmacy Provider Agreement to Express Scripts Canada at fax number 905-712-0669.
|
Quebec Pharmacies
|
The First Nations and Inuit Health (FNIH) Regional Office in Quebec maintains an umbrella agreement with the l’Association Québécoise des pharmaciens propriétaires (AQPP) on behalf of all pharmacies in Quebec, registered to provide services to NIHB clients.
|
|
The Pharmacy provider must contact AQPP to initiate the registration process, and the necessary documentation is then forwarded to Express Scripts Canada by fax to 905-712-0669.
|
Pharmacy Forms
Claims
NIHB Pharmacy Claim Form
Claims Submission Kit
NIHB Pharmacy Claims Submission Kit
NIHB Pharmacy Claims Submission Kit Attachments
Provider Information Changes
Modification to Pharmacy and Medical Supplies and Equipment Provider Information Form
Contacts
Express Scripts Canada Provider Claims Processing Call Centre
Health Canada
|
