Get Pharmacy Credentialing Form

Completing the Pharmacy Credentialing Form is an essential step for pharmacies aiming to join the CIGNA Healthcare’s Pharmacy Network. This guide will provide clear, step-by-step instructions to help users fill out the form correctly and efficiently.

Follow the steps to successfully complete the Pharmacy Credentialing Form.

1. Click 'Get Form' button to access the Pharmacy Credentialing Form and open it in your chosen online editor.
2. Fill out Section I, which requires general information about your pharmacy. Include information such as the legal name, DBA name, address, contact details, and relevant pharmacy numbers.
3. Complete Section II by describing the type of pharmacy services you provide. Indicate percentages for retail, specialty, and other services as applicable, and answer the accessibility questions.
4. In Section III, certify the accuracy of your pharmacy's operating practices and provide details regarding any previous issues related to DEA registration, malpractice suits, or felony convictions.
5. Sign and date Section IV to certify that all the information provided is accurate. Make sure to acknowledge the requirements and understand that submitting this application does not guarantee acceptance into the network.
6. If applicable, complete Sections V and VI on Medicare requirements and long-term care requirements, ensuring you include all necessary certifications and attestations regarding your adherence to regulations.
7. Once the form is complete, gather the required supporting documents, such as licenses and insurance policies, and attach these to your application.
8. Submit your completed application along with the attached documents to the specified mailing address. Note that faxed applications will not be accepted.
9. Finally, allow up to 10 business days for processing. Check your email or fax for any responses regarding your application status or any required follow-up.

Begin filling out the Pharmacy Credentialing Form online to take the next step in joining CIGNA's Pharmacy Network.