Get Pharmacy Accreditation Exemption Statement - Cms

Filling out the Pharmacy Accreditation Exemption Statement - Cms is an essential step for pharmacies seeking to enroll in Medicare without the need for accreditation. This guide provides clear, step-by-step instructions to assist you in completing the form accurately.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to retrieve the Pharmacy Accreditation Exemption Statement and open it for editing.
2. Begin by filling in the legal business name of your pharmacy in the designated section. Ensure that the name matches your enrollment records to avoid any discrepancies.
3. Next, provide the practice address location of your pharmacy. This should be the same address associated with your Medicare billing number.
4. Enter the Medicare billing number assigned to your pharmacy. This is crucial for verifying your enrollment status.
5. Complete the attestation by affirming that your pharmacy has been enrolled as a DMEPOS supplier for at least five years without any unrescinded adverse actions.
6. Indicate the percentage of total pharmacy sales attributed to DMEPOS billing. Ensure that it reflects less than five percent over the previous three calendar years.
7. Acknowledge that your pharmacy will comply with accreditation requirements if the criteria for exemption are no longer met. Provide an agreement to notify the relevant authorities within 30 days of any changes to compliance status.
8. After reviewing the completed form for accuracy, sign the attestation by the Authorized or Delegated Official as per the previously submitted CMS-855S Medicare enrollment application.
9. Finally, save your changes. You can then choose to download, print, or share the completed form as required.

Complete the Pharmacy Accreditation Exemption Statement - Cms online today for a smoother enrollment experience.