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| Pharmacy Network Application |
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Pharmacy Network Agreement and Application
The following documents are the Pharmacy Network Agreement and Application and Amendment #1 and #2 for pharmacies to join the network for the Oregon Prescription Drug Program (OPDP), effective June 1, 2008.
Please review the Agreement and both Amendments as they contain all the terms and conditions for a contract between the State of Oregon by and through its Oregon Prescription Drug Program, and the Pharmacy whose legal name is set forth on the attached Agreement.
Specific information is required on the Application for pharmacies to be enrolled in the OPDP network. Please download the attached Application and Amendment #1 and #2, fill in the blanks, sign and FAX only the signature page and Appendix A and Amendment #1 and #2 to Vika Shaulskaya at FAX # 503-378-6842.
If you are interested in taking advantage of the POS administration of Immunization & Vaccines, a form is available below to fill out and fax back also to the same #. OPDP will utilize this form to promote the I&V program as well as provide your information to members on this website. Pharmacies will receive a fee equal to that permitted by the Centers for Medicare and Medicaid Services (CMS) for Medicare reimbursement of such services. At August 2008 that fee is $20.00. Pharmacy will be reimbursed the dispensing fee as outlined in the contract.
1. PHARMACY NETWORK AGREEMENT-APPLICATION FORM
2. Pharmacy Network Amendment #1
3. Pharmacy Network Amendment #2
4. Immunization & Vaccine Administration form
If you have questions about the Agreements please call Betty Wilton at 503-373-1650, or email betty.wilton@state.or.us.
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