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How to use or fill out What is the NCPDP Provider ID? with our platform
- Click ‘Get Form’ to open the Provider Network Participation Request Form in the editor.
- Begin by entering today’s date in the designated field at the top of the form.
- Select your provider type by checking one of the boxes: Chain, PSAO, or Independent. Fill in your legal name and NCPDP/NPI number.
- If applicable, provide your affiliate code and name. Choose your pharmacy type from options like Retail, Clinic, or Mail.
- Complete your pharmacy address details including city, state, zip code, and contact information.
- In the Additional Information section, answer questions regarding PSAO affiliation and Medicaid dispensing status as required.
- Finally, fill out the Signature Information section with the name and title of the authorized individual before submitting via fax or email.
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