Forms for Pharmacies

5432

• PharmaCare Provider Enrolment form (HLTH 5432) (PDF, 585KB)

5432A

• Schedule A: Owner Details (PDF, 513KB)

5432B

• Schedule B: Additional Sites (PDF, 512KB)

5432C

• Schedule C: Additional Information (PDF, 498KB)

• PharmaCare Provider Change (HLTH 5433) (PDF, 746KB)

Note: If you want to be able to save a pdf form with the information you have entered, please:

• Download the form to your computer by right clicking and selecting "Save Target As" or "download linked file".
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• Enter your information, and save the file on your computer.
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5384

For information on whether or not your pharmacy may be eligible for the Rural Incentive Program, please see the Rural Incentive Program – Section 8.11, PharmaCare Policy Manual.

• Rural Incentive Program Application (PDF, 549KB)

5378

Use this form to document 2 to 27 days’ supplies of medications for frequent dispensing that have not authorized by the prescriber, as described in the Frequency of Dispensing Policy - Fee Limits – Section 8.3, PharmaCare Policy Manual.

• Frequent Dispensing Authorization

5425

For information on appropriate use of this form, please see Compound Prescriptions – Section 5.13, PharmaCare Policy Manual.

• Compound Costing Worksheet (PDF, 955KB)

Complete this form each time a patient is dispensed a smoking cessation prescription drug or nicotine replacement therapy (NRT) product through the BC Smoking Cessation Program.

• BC Smoking Cessation Program Declaration and Notification (PDF, 532KB)

Use this form to request the inactivation of specific text in the Adverse Reaction/Clinical Condition field of a patient’s PharmaNet profile.

• Request to Inactivate Adverse Reaction/Clinical Condition on PharmaNet Profile (PDF, 976KB)