Forms for Pharmacies

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PharmaCare Provider Enrollment

For information on these forms, please see the PharmaCare Provider Enrollment Guide (PDF, 260KB).

5432

5432A

5432B

5432C

5433

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Application for PharmaCare Rural Incentive Program

5384

For information on whether or not your pharmacy may be eligible for the Rural Incentive Program, please see the PharmaCare Policy Manual, Section 8.11 (PDF, 150KB).

Frequent Dispensing Authorization

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 PharmaCare Policy Manual, Section 8.3 (PDF, 795KB).

Compound Costing Worksheet

5425

For information on appropriate use of this form, please see the PharmaCare Policy Manual, Section 5.13 (PDF, 422KB).

Smoking Cessation Program

5464

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.

Adverse Reaction/Clinical Condition on PharmaNet Profile

5550

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