How do I enroll my pharmacy in the Bosentan Outpatient Pharmacy Enrollment Form? (Bosentan Outpatient Pharmacy Enrollment Form User Guide)

Answer

manuals.plus

Jan 13, 2025 - 01:04 AM

To enroll your pharmacy in the Bosentan REMS program, please follow these steps:

1. Review the Pharmacy Guide: Before completing the enrollment form, make sure to review the Pharmacy Guide provided by the Bosentan REMS program. This guide contains important information about the requirements and responsibilities of being a certified pharmacy.

2. Complete the Outpatient Pharmacy Enrollment Form: Fill out all the required fields in the enrollment form. This includes providing your pharmacy's name, NCPDP, NPI, and DEA identifiers, address, phone number, and fax number. You will also need to provide the information of the authorized representative, including their name, credentials, office phone, fax, and email.

3. Choose the method of submission: There are two options for submitting the enrollment form. You can either complete the form online by visiting www.BosentanREMSProgram.com and scanning the Quick Response (QR) code, or you can fax or mail the completed form. If you choose the latter option, fax the form to 1-800-730-8231 or mail it to the Bosentan REMS at 200 Pinecrest Plaza Morgantown, WV 26505.

4. Await certification notification: Once you have submitted the enrollment form, the Bosentan REMS will review your application. If everything is in order, they will notify you of successful certification. If you have any questions or need additional information, you can visit www.BosentanREMSProgram.com or call the Bosentan REMS at 1-866-359-2612.

Remember, as the authorized representative of your pharmacy, it is your responsibility to ensure compliance with the Bosentan REMS requirements. This includes training relevant staff, obtaining authorization for each prescription, counseling patients on risks, reporting adverse events and pregnancies, and maintaining records of dispensing and training.