Pharmacy Telephone Number Sample Clauses

Pharmacy Telephone Number. A) Number of clients receiving Methadone supervised consumption for at least 14 days in the month being claimed for @ £43.20/month
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Pharmacy Telephone Number. Community Pharmacy Needle Exchange (CPNx) ~ Monthly Invoice Month claimed for ………………………………. Year:………………………….. Total Claim: Retainer fee (1/12 of £150.00) £12.50 = £12.50 Total Number of Exchanges ……….... x £1.58 = These fees are fully inclusive of VAT Total £ I certify that I have provided needle Exchange services for the number of times stated above and that this can be confirmed by entries in my monitoring forms. Signed …………………………………… Date…………………………………….. Name (print)………………………………Designation…………………………….. Please complete and return this form to: CPNx Service Commissioner Stockton Drug action Team, Tithebarn House, High Newham Court, Hardwick Xxxxxxxx on Tees TS19. FOR DAT/PCT use only Claim checked by ………………………………………………………………. Claim authorised by…………………………………………...Date……………… Stockton-on-Tees Teaching Primary Care Trust Appendix 2(B) Pharmaceutical services to Drug users Community Pharmacy Needle Exchange (CPNx) ~ Claim for setting up costs Pharmacy Name: Pharmacy Stamp Pharmacy Address: Pharmacy Telephone Number: Accreditation requirements Date Signature Designated Lead completed CPPE training ( copy of certificate submitted) Standard operating procedure in place ( copy submitted as evidence) Training provided by service co-ordinator (High Street Project) Premises approved by service co-ordinator (High Street Project) Total Claim: Setting up fee for the provision of Community Pharmacy Needle Exchange(CPNx) = £500.00 I certify that the community pharmacy named above meets the accreditation requirements for the provision of community pharmacy needle exchange services (CPNx). Signed …………………………………… Date………………………………. Name (print)…………………………………Designation…………………….…. Please complete and return this form to: CPNx Service Commissioner Stockton Drug action Team, Tithebarn House, High Newham Court, Xxxxxxxx Xxxxxxxx on Tees XX00 0XX. FOR DAT/PCT use only Claim checked by ………………………………………………………………. Claim authorised by…………………………………………...Date……………… Stockton-on-Tees Teaching Primary Care Trust Appendix 3 Pharmaceutical services to Drug users Transaction form Records of transactions to be submitted to service co-coordinator by fax by the 5th of the month for the service provided in the previous month. A copy of the transactions to be sent to the service commissioner (Stockton DAT) with the monthly invoice. Details to be provided by CPNx Pharmacy coordinator Appendix 3A Pharmaceutical services to Drug users Exchange request form Details to be provided by CPxPharmcy co-ordina...
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Pharmacy Telephone Number. Total Claim: Start up fee On behalf of the above pharmacy contractor, I certify agreement to provide ‘Healthy Heart Check’ services according to the Service Level Agreement. Signed …………………………………… Date………………………………. Name (print)……………………………………. Job Title………………………………………….. Pharmacy stamp Payment arrangements (eg Cheques payable to) Please complete and return this form return by post or fax to: Xxxxx Xxxxxxx, Public Health Portfolio Manager, NHS Stockton, Xxxxx Xxxxx, Xxxxxxxx Xxxxx, Xxxxxxxx xx Xxxx XX00 0XX Fax No: 00000 000000 Community Pharmacy CVD Screening Enhanced Service Version 4a – Phase 1 2009 44 Appendix 11 Hartlepool Middlesbrough Stockton on Tees Redcar and Cleveland Monthly Claim Form for Health Heart Check Please complete and return before the 7th of the month to: Contractor Claims Section Xxxxx Xxxxx Xxxxxxxxx Xxxx Xxxxxxxxx XX0 0XX Name and location of Pharmacy Pharmacy Code (if provided) Vat No. Month and Year
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Pharmacy Telephone Number. Community Pharmacy Pregnancy Testing and Support Service (PTS) ~ Monthly Invoice Month claimed for ………………………………. Year:………………………….. Total claim Quantity Fee Total Monthly Retainer fee £ (fully inclusive of VAT) £12.50 (inc VAT) Total number of pregnancy test and support sessions ( fully inclusive of VAT) @ £11.75 (inc VAT) Total costs for month Please complete and return this form to: Sexual Health co-ordinator, NTPCT Public Health Department .Newtown Resource Centre Durham road Stockton on Tees North Tees Primary Care Trust FOR PCT USE ONLY: Claim checked and authorised by Signature Name Date North Tees Primary Care Trust Appendix F: Contact details (to follow)
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Related to Pharmacy Telephone Number

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