Date

 

Martin Honig

Manager, Pharmacy Networks

Wellpoint Pharmacy Management

PO Box 5012

Thousand Oaks, CA 91359-9721

 

 

Dear Sir,

 

We are requesting inclusion in the contract serving Idaho residence with the same terms, conditions, copays, and dispensing limits as your mail order service. I am entitled to this contract under the Idaho Any Willing Provider Law, as long as I meet the same terms.

 

The reimbursement rate, as I understand it is:

 

Brand AWP-19%

Generic AWP-55%

Brand and Generic Dispensing Fee $1.25

 

 

 

I would appreciate hearing from you by letter of fax no later than 2 weeks

 

Sincerely,

 

 

 

Signature

Include NABP #

 

CC: Shad Priest, State of Idaho Deputy Attorney General,

Dale Freeman, Consumer Affairs Supervisor, State of Idaho Department of Insurance

JoAn Condie, Executive Director Idaho Pharmacy Association