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Revised January, 2010 CONFIDENTIAL AND PROPRIETARY - page 22 / 31





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Signature Logs

Signature logs are defined as the permanent dispensing log of prescriptions. They are defined herein and according to the Pharmacy Network Agreement. Pharmacy shall maintain a signature log listing the plan name, prescription number, and service date, and require an eligible member or representative who receives a covered drug to sign the log. Walgreens Health Initiatives also accepts electronic signature logs. Delivery logs are accepted according to Walgreens Health Initiatives’ discretion and must contain the necessary elements held by the signature log requirements. Incomplete and/or unsigned signature logs may result in chargebacks.

Documentation Requirements

In accordance with the Access to and Retention of Records set forth in the Pharmacy Network Agreement, the pharmacy is required to make available and/or furnish Walgreens Health Initiatives or its delegate with the following documentation upon request: prescription files, original prescription hard copies, signature logs and records, and policies and procedures of the pharmacy. Documentation must be readily available and retrievable. Hardcopy prescriptions must be authorized and updated annually, unless otherwise required by applicable state or federal law, in order for refills to be valid post the original hard copy’s expiration.

Unacceptable audit findings as a result of continual errors by a pharmacy in the following documentation and quantity/dispensing limit categories may result in chargebacks, financial penalties, and/or removal from the network.

Required Rx Elements Patient name, valid date, name of medication, dosage strength, directions (‘as directed’ sigs are not acceptable), quantity, refill information, prescriber’s signature or RPh notation for called-in scripts and DAW code indication must be included on all hard copy prescriptions/physician orders.

Prescriber submissions All claims must be submitted using the prescriber ID (state license ID, DEA number or NPI) correlating to the prescribing physician.

Refill authorization All refills must be authorized by either a new prescription hard copy issued to the patient by the prescriber, a faxed prescription refill authorization signed by the prescriber or the prescriber’s agent, or a properly-documented pharmacy prescription pad or system annotation in cases of a called-in refill authorization.

Walgreens Health Initiatives – Pharmacy Manual


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