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Revised January, 2010 CONFIDENTIAL AND PROPRIETARY - page 4 / 31





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Walgreens Health Initiatives’ Overview

Walgreens Health Initiatives, Inc. is pleased to welcome you to our network of participating pharmacies. We look forward to working with you to provide accessible, cost-effective, quality pharmacy services to our clients’ members.

This manual is intended as a guide for your pharmacy staff in claims processing, and provides general terms, conditions, procedures, and policies of Walgreens Health Initiatives. Online claims adjudication and messaging reflect the most current benefits. Please also refer to your most recent Pharmacy Network Agreement for network participation requirements, which will control in the case of any conflict between this manual and the Pharmacy Network Agreement.

We hope that your day-to-day questions concerning Walgreens Health Initiatives’ pharmacy programs are adequately addressed in this manual. If you have questions or require additional information, please refer to the “Provider Relations Department” section of this manual.

Walgreens Health Initiatives entered the PBM industry in January 1996 and services local, regional, and national clients via a network of pharmacies nationwide. We appreciate your participation in our provider network, allowing us to extend our services to patients in your area.

Member Eligibility

Any questions regarding member eligibility should be directed to the Walgreens Health Initiatives Customer Care Center (toll free) at 800-207-2568.

Identification Card

Walgreens Health Initiatives’ members are provided an identification card. Members are instructed to present their ID card when obtaining a prescription from a network pharmacy. When submitting a claim for services, it is important that you ask to see the member’s ID card and the name of the member. If no ID card is presented, and eligibility for which the prescription is written cannot be confirmed through the POS System or through our Customer Care Center, then the patient should be notified, and the pharmacy may apply its standard operating procedure.

A pharmacist can verify a member’s coverage by submitting the information noted on the member’s ID card. If an “invalid” response is received, please check that all submitted information matches the elements on the ID card.

Here is the Information that generally appears on the member’s Walgreens Health Initiatives Identification Card (Figure 1 below is an example ID card). This information is required to file a claim:

Walgreens Health Initiatives – Pharmacy Manual


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