Request for Grant Assistance to Cover Contraception Consultation Fees
For Uncompensated Care
Increasing access to oral contraceptives is an important service that allows women more control and choice in their life. There is a great need in this state and we are proud of pharmacists that have stepped up to offer this care. To get this program off to a good start when payers often lag behind in adopting payment mechanisms, the APA has solicited grant funding from a generous and anonymous donor to cover uncompensated care. Pharmacies will be provided a $75 to reimburse you for your time and expertise for a full clinical evaluation, consultation, and documentation (typically lasting approximately 30 min).
Currently paying pharmacies directly. We could pay pharmacists individually, but this would require a 1099 for tax purposes.
Street Address Line 2
State / Province
Postal / Zip Code
Number of Uncompensated Consultations
Encounters requiring a full clinical evaluation, consultation and documentation (usually 30 min or greater)
Rx numbers for pharmacist generated prescriptions
Only required in case of an unlikely audit
Questions, suggestions, feedback, etc.
Should be Empty: