RESIDENT—PHARMACY AGREEMENTPharmacy Agreement • September 11th, 2024
I, , authorize Guardian Pharmacy, (referred to this agreement as the “Pharmacy”) to provide medications and associated products and services to the above named Resident. If signing this Agreement as an agent of the Resident pursuant to a Power of Attorney (POA), I certify that I have legal authority to sign this agreement on the Residents’ behalf. I have provided the Community/Organization listed above with the most current and accurate medical records for the Resident (the “Records”) and authorize the Community/Organization to provide the Pharmacy with all Records in its possession or control. I further acknowledge and approve that, when necessary, any information with the possession or control of the Community/Organization may be relayed to the Pharmacy through any secured means including, but not limited to verbal communications in person or over the phone or via secured email. By my signature, I also permit the Community/ Organization to continue to notify and provide the Pharmacy
PHARMACY AGREEMENTPharmacy Agreement • July 26th, 2022
,(the "Effective Date") by and between Tilray Australia New Zealand Pty Ltd, an Australian corporation (“Tilray”), and XXXX Pharmacy, an Australian corporation (the "Retailer").
PHARMACY AGREEMENTPharmacy Agreement • January 30th, 2021
WHEREAS, This Agreement specifies distinct pharmacy services (Services) to be delivered by Pharmacy in relation to the conduct of STUDY TITLE (Study) at Name and full address of institution (Institution), in strict adherence to Protocol No. XXXXXXXXX (Protocol), which is sponsored by Name and full address of sponsor (Sponsor).
Pharmacy Operator: please check off applicable boxPharmacy Agreement • May 5th, 2020 • Manitoba
independent banner chain supermarket or merchandise outlet franchise regional health authority not-for-profit health corporation
RIVERSIDE PHARMACYPharmacy Agreement • July 23rd, 2021
Riverside Pharmacy's monthly billing cycle ends on the 25th of each month. The undersigned agrees to pay the statement balance within 15 days after receipt of statement. Interest is charged on accounts over 30 days past due at a periodic rate of 1.5%. Any account not kept current will result in disconituation of the account and services. Services will resume once payment of the outstanding balance is made.
ContractPharmacy Agreement • May 18th, 2020
PHARMACY AGREEMENT SMLOUVA S LÉKÁRNOU (For Use in the Czech Republic) (Pro použití v České republice) STUDY / SITE NO. STUDIE / ČÍSLO MÍSTA HODNOCENÍ XXX / XXX This agreement (hereinafter called “Agreement”) is entered by and among: Tato smlouva (dále jen „Smlouva“) je uzavřenamezi: MERCK SHARP & DOHME, s.r.o., with its MERCK SHARP & DOHME, s.r.o., se sídlem address at Na Valentince 3336/4, Prague 5, ZIP Na Valentince 3336/4, Praha 5, 150 00, Česká code 150 00, ID: 284 62 564, tax ID: CZ 284 62 republika, IČ: 28462564, DIČ: CZ28462564, 564, registered in the Companies Register zapsaná v obchodním rejstříku vedeném Městským maintained by the Municipal Court in Prague soudem v Praze (oddíl C vložka 143294), jednající (Section C, File No. 143294), acting in its own svým jménem na žádost společnosti Merck Sharp name at the request of Merck Sharp & Dohme & Dohme Corp., se sídlem One Merck Drive, Corp. with its address at One Merck Drive, Whitehouse Station, New Jersey 08889, Spojené Whiteho
PHARMACY AGREEMENT/MEDICAL ASSISTANCE PROGRAM NORTH DAKOTA DEPARTMENT OF HUMAN SERVICES/MEDICAL SERVICES SFN 1169 (3-2018)Pharmacy Agreement • March 16th, 2018
This agreement between the North Dakota (ND) Department of Human Services (hereinafter referred to as "Department"), State Capitol, Bismarck, North Dakota and:
Pharmacy Agreement (for the supply of Medication to a Patient/Participant) Parties to this Agreement:Pharmacy Agreement • October 17th, 2018
The House Operator provides supported independent living disability support services to the Patient. This Pharmacy Agreement is made to support correct administration of medication to the Patient.
PHARMACY AGREEMENT FORMPharmacy Agreement • January 3rd, 2023
Pharmacies must designate an authorized representative to carry out the certification process and oversee implementation and compliance with the Mifepristone REMS Program on behalf of the pharmacy.
No agreement required between Ventegra and dispensaries.Pharmacy Agreement • November 21st, 2016
PURPOSEPharmacy Agreement • June 17th, 2015
Used by pharmacies that have signed a working agreement (DSB-4020: Pharmacy Agreement) with the Division of Services for the Blind (DSB) to provide pharmaceutical services to eligible individuals of the agency. These drugs include those authorized for diagnostic, palliative, or therapeutic purposes.
Good Day PharmacyPharmacy Agreement • July 12th, 2021
This form authorizes Good Day Pharmacy to provide medications to the individual (resident) named below and provides that financial responsibility incurred from the medications will be paid by the resident, spouse or Legally Responsible Representative (Guarantor).
Good Day PharmacyPharmacy Agreement • July 12th, 2021
This form authorizes Good Day Pharmacy to provide medications to the individual (resident) named below and provides that financial responsibility incurred from the medications will be paid by the resident, spouse or Legally Responsible Representative (Guarantor).
PHARMACY AGREEMENTPharmacy Agreement • November 1st, 2022
DSB-0511 PHARMACY BILLING FORMPharmacy Agreement • April 17th, 2019
DSB-0511 is used by pharmacies that have signed a working agreement (DSB-4020: Pharmacy Agreement) with the Division of Services for the Blind to provide pharmaceutical services to consumers of the agency. These drugs include those authorized for individual consumers for diagnostic, palliative, or therapeutic purposes.
PROVINCE AND PHARMACISTS REACH ONE-YEAR AGREEMENTPharmacy Agreement • October 30th, 2018
As of October 22, pharmacists are being funded to give flu shots to children ages five to eight as well as to people living in settings such as personal care homes and assisted living apartments. Previously under the province’s publicly- funded influenza vaccination program, pharmacists gave flu shots to people aged nine and older at pharmacies only.
Best PricePharmacy Agreement • December 16th, 2002
Alberta Blue Cross pays out hundreds of millions of dollars in claims each year. We pay dentists, pharmacies, ambulance operators and hospitals. All these providers trust us because we’re fair, efficient and prompt.
Referred Care Clinic - YukonPharmacy Agreement • August 4th, 2020
Pharmacy Agreement Amendment:Pharmacy Agreement • March 1st, 2019
This past December, RxA submitted a written request to Government asking for the elimination of the Holdback Policy and an extension of the financial terms of the agreements. Last Spring, the new agreement established significant measures meant to mitigate Government spend on the pharmacy compensation budget. These measures including the frequent dispense policy, and changes to the Pharmacy Services Framework, resulted in cost savings greater than anticipated, with trending expected to be below budget target for 2018/19.
Pharmacy AgreementPharmacy Agreement • July 30th, 2020
PHARMACY AGREEMENTPharmacy Agreement • January 10th, 2017
PHARMACY INFORMATION (complete all fields) – Pharmacy must be licensed in GeorgiaPharmacy Agreement • August 22nd, 2019
This is an agreement between the above listed agencies relative to the control, procurement, handling, and accountability of drugs and intravenous fluids (IVs). Attached to this document are copies of all appropriate agreements and contracts between the above-mentioned EMS Provider and Georgia Licensed Pharmacy or Wholesaler and a list of pharmaceutical agents approved for use, and related policies established and signed by the Medical Director of the licensed emergency medical service provider (“EMS Medical Director”). This agreement will be valid for a maximum of twenty five (25) months from the date of signing and must be renewed in conjunction with the license renewal, prior to the expiration of the twenty five (25) months.
PHARMACY AGREEMENTPharmacy Agreement • September 25th, 2023
In consideration of the mutual agreements and promises hereinafter set forth, the sufficiency and adequacy of which are hereby acknowledged, the parties hereto agree as follows:
Pharmacy Operator: please check off ✓ applicable boxPharmacy Agreement • August 3rd, 2021 • Manitoba
🗌 independent 🗌 banner 🗌 chain 🗌 supermarket or merchandise outlet 🗌 franchise 🗌 regional health authority 🗌 not-for-profit health corporation
