Get Pharmacy Credentialing Form Only - Catamaran

Filling out the Pharmacy Credentialing Form is a crucial step in ensuring your participation in the Catamaran Provider Network. This guide provides step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the Pharmacy Credentialing Form.

1. Press ‘Get Form’ button to obtain the form and access it for completion.
2. In the General Information section, provide your pharmacy's legal name, doing business as (D/B/A) name, NCPDP number, NPI number, physical address including city and ZIP code, phone, and fax numbers, along with your email.
3. Move to the Payment Information section and enter the mailing or remittance address, including city, state, and ZIP code. Specify the ownership type and provide the corporation name and owners' names along with their addresses.
4. Next, complete the Licensure & Certification section. Fill out the DEA number, expiration date, state license number, liability insurance details, Medicaid and Medicare numbers, and sterile compliance number if applicable.
5. Proceed to the Pharmacy Service and Type section, answering questions regarding emergency services, delivery options, internet service availability, and any fees applicable. Also, indicate which languages are spoken in your pharmacy.
6. In the Compliance and Attestation section, carefully answer the questions related to contracting groups, ownership changes, license suspensions, and compliance with federal regulations.
7. For the Medicare Conflict of Interest and OIG and GSA Certification, provide initials to confirm you have necessary policies in place.
8. Complete the Long Term Care (LTC) Service & Requirements section if applicable, indicating the services provided by your pharmacy.
9. List all employees, including owners, pharmacy manager, pharmacist in charge, and pharmacy technicians with relevant details such as names, dates of birth, and licenses.
10. Finally, sign and certify the form by providing your name, title, and date, confirming the accuracy of the information.
11. Upon completion, save your changes, and you can choose to download, print, or share the form as necessary. Ensure you submit it as directed.

Complete your Pharmacy Credentialing Form online today to maintain network participation.