ContractCentral Fill Pharmacy Agreement • February 22nd, 2018
THIS CENTRAL FILL PHARMACY AGREEMENT is entered into effective, (“effective date”), by and between, , a limited liability company and OPS INTERNATIONAL, INC DBA OLYMPIA PHARMACY, a Florida corporation company.
CENTRAL FILL PHARMACY AGREEMENT NOTIFICATION FORMCentral Fill Pharmacy Agreement • September 14th, 2021
Originating Pharmacy Centralized Processing Pharmacy Pharmacy name: Pharmacy name: Certificate of Operation #: Certificate of Operation #: 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:
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:
Appendix ACentral Fill Pharmacy Agreement • August 1st, 2024
provides pharmacy services to the Originating Pharmacy under the terms of a written contract that includes the terms required by Council.
