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  • Pharmacy Service Appointment Form

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  • There is a $50 fee for Pharmacist Assessment for Self-Administered Hormonal Contraception.  This fee is independent of any hormonal contraception product provided.  Fee will be charged even if it is determined that a self-administered option is not appropriate, or if referral to a physician is required.  If possible we will bill your insurance for this fee.*  Fee is due at time of service.

     

     *Currently accepted plans for Pharmacist Assessment: 

    - New York Medicaid

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