Participating Pharmacy definition
Examples of Participating Pharmacy in a sentence
Pricing in the 31 – 90 Days’ Supply column in the table set forth above is applicable only if Sponsor implements a plan design that requires Members to fill such days’ supply at a Maintenance Network Participating Pharmacy (i.e., Sponsor must implement a plan design whereby Members who fill extended days’ supply prescriptions at a Participating Pharmacy other than a Maintenance Network Participating Pharmacy do not receive benefit coverage under the Plan for such prescription).
If no such plan design is implemented, the pricing for such days’ supply will be the same as for Prescription Drug Claims for less than a 31 days’ supply, and pricing for a 31 – 90 days’ supply in the table set forth above shall not apply, even if a Maintenance Network Participating Pharmacy is used.
ESI shall have no liability to Sponsor, any Member or any other person or entity for any act or omission of any Participating Pharmacy or it agents or employees.
In any instance where the audit demonstrates that the amount billed to you does not equal the Pass-Through amount paid to the Participating Pharmacy, you or your auditor may perform an on-site audit of the applicable Participating Pharmacy contract rate sheet(s).
If no such plan design is implemented, Rebate Amounts for such days’ supply will be the same as for Prescription Drug Claims for less than an 31 days’ supply, and Rebate Amounts for an 31 – 90 days’ supply in the table set forth above shall not apply, even if a Maintenance Network Participating Pharmacy is used.