Common Contracts
1 similar Central Fill Pharmacy Agreement contracts
CENTRAL FILL PHARMACY AGREEMENT NOTIFICATION FORMCentral Fill Pharmacy Agreement • September 3rd, 2021
Originating Pharmacy Centralized Processing Pharmacy Pharmacy name: Pharmacy name: Pharmacy NBCP Accreditation #: Pharmacy NBCP Accreditation #: Pharmacy address: Pharmacy address: Pharmacy Telephone #: Pharmacy Telephone #: Pharmacy email address: Pharmacy email address: Proposed date for start of Centralized Drug order processing: Proposed date for start of Centralized Drug order processing: Pharmacy Manager name: Pharmacy Manager name: Pharmacy Manager NBCP License #: Pharmacy Manager NBCP License #: I certify that there is a written agreement between the pharmacies named and I understand the responsibilities and will comply with the NBCP Centralized Drug Order Processing (Central Fill) PracticeDirective. x x Originating Pharmacy -Signature of Pharmacy Manager Central Fill Pharmacy- Signature of Pharmacy Manager Date: Date:
