Get Cigna Pharmacy Credentialing Application Form 2008

Filling out the Cigna Pharmacy Credentialing Application Form is a crucial step for any pharmacy wishing to join the Cigna Healthcare Pharmacy Network. This guide will provide you with clear, step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to successfully complete the application form.

1. Press the ‘Get Form’ button to access the application form and open it in your document editor.
2. Begin by completing Sections I and II. Provide the legal name of your pharmacy, DBA name, NCPDP number, NPI number, and all contact information as listed. Make sure to fill in any fields related to the location and owner of the pharmacy.
3. Next, in Section II, indicate the type of services your pharmacy provides and the approximate percentage of your business represented by each. Ensure you check all applicable boxes.
4. Proceed to Section III. Initial where required and answer questions about your pharmacy's licensure, malpractice history, and any legal issues. If applicable, provide clarifications for any 'yes' responses.
5. In Section IV, review the certification section and acknowledge that all information provided is accurate. Make sure to sign and date the form to complete this section.
6. If applicable, complete Sections V and VI, which include additional Medicare and long-term care requirements. Initial where necessary to certify your agreement.
7. Finally, ensure that you attach copies of required documents as mentioned in the instructions, and mail your completed application and attachments to the specified address. Remember that faxed applications will not be accepted.
8. Allow up to 10 business days for Cigna to review and respond to your application.

Begin your application process today by filling out the Cigna Pharmacy Credentialing Application Form online.