Get Usscript Pharmacy Price Inquiry Form 2014-2025

The USScript Pharmacy Price Inquiry Form is designed to assist pharmacies in obtaining pricing information. This guide will walk you through each section of the form to ensure accurate completion.

Follow the steps to successfully complete your form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online document editor.
2. Indicate whether this is your first or second request by checking the appropriate box at the top of the form.
3. In the 'Claim Information' section, fill in the required fields: enter the *Rx Number and the *Date of Fill.
4. In the 'Pharmacy Information' section, provide the necessary details including: - *Contact Person - *NCPDP # (7 digits) - *Chain/PSAO ID # (3 digits) - *Pharmacy Name - *Phone - **Fax - *City - *Zip - **Email - *State.
5. Proceed to the 'Drug Information' section and complete the following fields: - *Drug name and strength - *NDC# (12 digits) - *Dosage form - **Metric quantity that was dispensed.
6. For the pricing details, ensure to provide the lowest price attainable for the dispensed amount and include the *Wholesaler information.
7. Read the notes regarding claim processing policies and ensure a processed claim is in place to qualify for pricing review.
8. Once all sections are completed, you can save your changes, download the form, print it for your records, or share it as needed.

Complete your USScript Pharmacy Price Inquiry Form online today for a smooth pricing inquiry experience.