Pharmacy credentialing application: Fill out & sign online

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01. Edit your pharmacy credentialing application online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

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Click ‘Get Form’ to open the pharmacy credentialing application in the editor.
Begin by filling out the 'General Provider Information' section. Ensure you provide your NCPDP number, legal name, and physical address accurately.
In the 'Contact Information' section, enter your mailing address and contact details. This is crucial for communication regarding your application.
Complete the 'Pharmacy Operations' section by indicating whether you provide emergency services or delivery options. Be specific about your hours of operation.
Fill out the 'Ownership Information' and 'Pharmacy Staff' sections with accurate details about ownership percentages and licensed professionals.
Review all sections for completeness. Incomplete submissions will not be accepted, so double-check that all applicable fields are populated.
Once completed, save your document and return it via fax or email as specified in the instructions.

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