Participating Pharmacy Sample Clauses

Participating Pharmacy. When You go to a Participating Pharmacy, You must pay any Copayment and any applicable pricing differences. You may be required to pay for limited or non- Covered Services. No claim forms are required. If You are unsure whether a Pharmacy is a Participating Pharmacy, You may access the website at xxx.xxxxxx.xxx (Provider Finder) or contact customer service at the toll- free number on Your identification card.
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Participating Pharmacy. We will only pay for medications prescribed for use outside the hospital. Except in an emergency, the prescription must be written by a participating provider and must be dispensed by a participating pharmacy. Exclusions and Restrictions. Under this section, we will not pay for the following: • Administration or injection of medications; • Replacement of lost or stolen prescriptions; • Medications prescribed for cosmetic reasons, unless they are necessary from a medical point of view. • Experimental medications or medications in research, unless they are recommended by an outside appeals agent; • Medications not approved by the FDA except for a prescribed medication that is approved by the FDA for the treatment of cancer when the medication is prescribed for a ditferent type of cancer than the type for which it was approved by the FDA. Nonetheless, the medication must be recognized for the treatment of the type of cancer for which it was prescribed by one of these publications: – AMA Drug Evaluations – American Hospital Formulary Service – U.S. Pharmacopoeia Drug Information – A review article or editorial comment in a major peer-reviewed professional journal • Nutritional supplements taken optionally; and • Devices and materials of all types, except family planning or birth control devices, basal thermometers, female and male condoms and diaphragms. • Prescribed medications and biological products and the administration of these medications and biological products provided with the intention of causing or helping to cause death, suicide, euthanasia or the compassionate killing of a person. • Medications prescribed for purposes of treating erectile dysfunction.
Sample 1
Participating Pharmacy. We will only pay for prescription drugs for use outside of a Hospital. The prescription must be issued by a Participating Provider and filled at a Participating Pharmacy, except in an emergency or where otherwise authorized by Us.
Sample 1
Participating Pharmacy. A Participating Pharmacy is a Pharmacy which has a Participating Pharmacy Agreement in effect with the Pharmacy Benefits Manager at the time services are rendered. Call your local Pharmacy to determine whether it is a Participating Pharmacy or call the toll-free customer service telephone number.
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Participating Pharmacy. Any registered, licensed retail pharmacy with whom the pharmacy benefit administrator or We have a contract to dispense Prescription Drugs to Members.
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Participating Pharmacy. Any Pharmacy, including a mail order pharmacy, which has entered into a Prepaid Prescription Agreement with Blue Cross and Blue Shield of New Jersey, Inc. or any other Participating Blue Cross Plan indicated by Blues Cross and Blue Shield of New Jersey, Inc.
Sample 1
Participating Pharmacy. Any contract between an insurer and a participating pharmacy or its contracting agency that requires claims to be submitted electronically shall require that payment is to be made electronically to the participating provider or its designee for clean claims submitted electronically or if electronic payment is requested by the provider. Prohibited Provisions
Sample 1
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Participating Pharmacy. We will only pay for prescription drugs prescribed for use outside of a Hospital. Except in an emergency, the prescription must be issued by a Participating Provider and filled at a Participating Pharmacy. Exclusions and Limitations SECTION SEVEN: OTHER COVERED SERVICES Under this Section, we will not pay for the following: • Administration or injection of any drugs. • Replacement of lost or stolen prescriptions. • Prescribed drugs used for cosmetic purposes only. • Experimental or investigational drugs. • Non-FDA approved drugs except that we will pay for a prescription drug that is approved by the FDA for treatment of cancer when the drug is prescribed for a different type of cancer than the type for which the FDA approval was obtained. However, the drug must be recognized for treatment of the type of cancer for which it has been prescribed by one of these publications: - AMA Drug Evaluations; - American Hospital Formulary Service; - U.S. Pharmacopoeia Drug Information; or • A review article or editorial comment in a major peer-reviewed professional journal. • Devices and supplies of any kind, except family planning or contraceptive devices, basal thermometers, male and female condoms, and diaphragms. • Prescribed drugs and biologicals and the administration of these drugs and biologicals that are furnished for the purpose of causing or assisting in causing the death, suicide, euthanasia or mercy killing of a person. • Prescription drugs used for purposes of treating erectile dysfunction. Home Health Care We will pay for up to forty visits per calendar year for home health care provided by a certified home health agency that is a Participating Provider. We will pay for home health care only if you would have to be admitted to a Hospital if home care was not provided. Home care includes one or more of the following services: • Part-time or intermittent home nursing care by or under the supervision of a registered professional nurse; • Part-time or intermittent home health aide services which consist primarily of caring for the patient; • Physical, occupational or speech therapy if provided by the home health agency; and • Medical supplies, drugs and medications prescribed by a physician and laboratory services by or on behalf of a certified home health agency to the extent such items would have been covered if the covered person had been in a Hospital. Preadmission Testing We will pay for preadmission testing when performed at the Hospital where surgery i...
Sample 1
Participating Pharmacy. Present your written prescription from your physician and your Identification Card to the pharmacist at a Participating Pharmacy. The Participating Pharmacy will file your claim for you. You will be charged at the point of purchase for applicable Deductible and/or Copayment or Coinsurance amounts. If you do not present your Identification Card, you will have to pay the full retail price of the prescription. If you do pay the full charge and you believe the Prescription Drug should be covered, ask your pharmacist for an itemized receipt and submit it to us for reimbursement consideration.
Sample 1

Related to Participating Pharmacy

  • Participating Provider A Provider that has a Provider Agreement with United Concordia Dental pertaining to payment for Covered Services rendered to a Member.

  • Participating Providers To find out if a Provider is a Participating Provider: • Check Our Provider directory, available at Your request; • Call the number on Your ID card; or • Visit our website at xxx.xxxxxx.xxx. The Provider directory will give You the following information about Our Participating Providers: • Name, address, and telephone number; • Specialty; • Board certification (if applicable); • Languages spoken; and • Whether the Participating Provider is accepting new patients.

  • Participating FFI The term Participating FFI means a Financial Institution that has agreed to comply with the requirements of an FFI Agreement, including a Financial Institution described in a Model 2 IGA that has agreed to comply with the requirements of an FFI Agreement. The term Participating FFI also includes a qualified intermediary branch of a Reporting U.S. Financial Institution, unless such branch is a Reporting Model 1

  • Pharmacy Pharmacy hereby represents that neither Pharmacy, nor, to the best of Pharmacy’s knowledge, Pharmacist, Pharmacy’s employees, agents or independent contractors involved in the provision of services have been excluded from participation in any Federally-funded health care programs, including, but not limited to, Medicare and Medicaid.

  • Designated Prescription Drug Prescribers and Pharmacies We may limit your selection of a pharmacy to a single pharmacy location and/or a single prescribing provider or practice. Those members subject to this designation include, but are not limited to, members that have a history of: • being prescribed prescription drugs by multiple providers; • having prescriptions drugs filled at multiple pharmacies; • being prescribed certain long acting opioids and other controlled substances, either in combination or separately, that suggests a need for monitoring due to: o quantities dispensed; o daily dosage range; or o the duration of therapy exceeds reasonable and established thresholds. The Amount You Pay for Prescription Drugs Our formulary includes a tiered copayment structure, which means the amount you pay for a prescription drug will vary by tier. See the Summary of Pharmacy Benefits for your copayment structure, benefit limits and the amount you pay. When you buy covered prescription drugs and diabetic equipment and supplies from a retail network pharmacy, you will be responsible for the copayment and deductible (if any) at the time of purchase. You will be responsible for paying the lower of your copayment, the retail cost of the drug, or the pharmacy allowance. Specialty prescription drugs are generally obtained from a specialty pharmacy. If you buy a specialty prescription drug from a retail network pharmacy, you will be responsible for a significantly higher out of pocket expense than if you bought the specialty drug from a specialty pharmacy. The amount you pay for the following prescription drugs is not subject to the tiered copayment structure: • Contraceptive methods; • Over-the-counter (OTC) preventive drugs; • Nicotine replacement therapy (NRT) and smoking cessation prescription drugs; • Infertility specialty prescription drugs; and • Covered diabetic equipment or supplies bought at a network pharmacy. See the Summary of Pharmacy Benefits for benefit limits and the amount you pay. This plan allows for medication synchronization in accordance with R.I. General Law

  • Supplier Diversity Seller shall comply with Xxxxx’s Supplier Diversity Program in accordance with Appendix V.

  • Medical Benefits - Prescription Drugs Administered by a Provider (other than a pharmacist) This plan covers prescription drugs as a medical benefit, referred to as “medical prescription drugs”, when the prescription drug requires administration (or the FDA approved recommendation is administration) by a licensed healthcare provider (other than a pharmacist). Please note: Specialty prescription drugs meeting these requirements or recommendations are covered as a pharmacy benefit and not a medical benefit. These medical prescription drugs include, but are not limited to, medications administered by infusion, injection, or inhalation, as well as nasal, topical or transdermal administered medications. For some of these medical prescription drugs, the cost of the prescription drug is included in the allowance for the medical service being provided, and is not separately reimbursed.

  • Participating Consumers All Participating Consumers as of the Effective Date will continue to be enrolled in the Program under the terms of this ESA unless they opt-out. Within one (1) day after the Effective Date, the Town shall provide to Competitive Supplier a list of Participating Consumers as of the Effective Date, as well as such Participating Consumers’ service and billing addresses, and any other information necessary for Competitive Supplier to commence All-Requirements Power Supply to such Participating Consumers as of the Service Commencement Date.

  • Medi Cal PII is information directly obtained in the course of performing an administrative function on behalf of Medi-Cal, such as determining Medi-Cal eligibility or conducting IHSS operations, that can be used alone, or in conjunction with any other information, to identify a specific individual. PII includes any information that can be used to search for or identify individuals, or can be used to access their files, such as name, social security number, date of birth, driver’s license number or identification number. PII may be electronic or paper. AGREEMENTS

  • Contractor Key Personnel ‌ The Contractor shall assign a Corporate OASIS Program Manager (COPM) and Corporate OASIS Contract Manager (COCM) as Contractor Key Personnel to represent the Contractor as primary points-of-contact to resolve issues, perform administrative duties, and other functions that may arise relating to OASIS and task orders solicited and awarded under XXXXX. Additional Key Personnel requirements may be designated by the OCO at the task order level. There is no minimum qualification requirements established for Contractor Key Personnel. Additionally, Contractor Key Personnel do not have to be full-time positions; however, the Contractor Key Personnel are expected to be fully proficient in the performance of their duties. The Contractor shall ensure that the OASIS CO has current point-of-contact information for both the COPM and COCM. In the event of a change to Contractor Key Personnel, the Contractor shall notify the OASIS CO and provide all Point of Contact information for the new Key Personnel within 5 calendar days of the change. All costs associated with Contractor Key Personnel duties shall be handled in accordance with the Contractor’s standard accounting practices; however, no costs for Contractor Key Personnel may be billed to the OASIS Program Office. Failure of Contractor Key Personnel to effectively and efficiently perform their duties will be construed as conduct detrimental to contract performance and may result in activation of Dormant Status and/or Off-Ramping (See Sections H.16. and H.17.).

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