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Please select the appropriate documentation link for registration in the NIHB Pharmacy Program:
Pharmacy Providers Outside Quebec
Pharmacy Providers In Quebec
Pharmacy Providers Outside Quebec
To register, download the Pharmacy Provider Agreement, complete all required sections, sign the Agreement, and return by fax to ESI Canada.
Fax No.: 905-712-0669
For further information, contact the Provider Claims Processing Call Centre:
Phone No.: 1-888-511-4666
Monday to Friday:
6:30 a.m. to 12 a.m. Eastern Time
Saturday, Sunday and Statutory Holidays:
8 a.m. to 12 a.m. Eastern Time
FULL SET OF ALL REGISTRATION FORMS FOR PHARMACY PROVIDERS
NIHB
Pharmacy Claims Submission Kit
NIHB
Pharmacy Claims Submission Kit Attachment
ESI Canada Pharmacy Provider Agreement
ESI Canada Pharmacy Provider Agreement (Sample)
NIHB
Pharmacy Claim Form
Provider Statement - Pharmacy (Sample)
Prior Approval Confirmation Letter (Sample)
ESI Canada Modification to Pharmacy-Medical Supplies and Equipment (MS&E) Information Form
Pharmacy Providers in Quebec
The First Nations and Inuit Health (FNIH) Regional Office in Quebec
maintains an umbrella agreement with the l’Association Québécoise
des pharmaciens propriétaires (AQPP) on behalf of all pharmacies in
Quebec, registered to provide services to NIHB clients.
The Pharmacy provider must contact AQPP to initiate the registration
process, and the necessary documentation is then forwarded to ESI Canada by fax at 905-712-0669.
For further information, contact the Provider Claims Processing Call Centre:
Phone No.: 1-888-511-4666
Monday to Friday:
6:30 a.m. to 12 a.m. Eastern Time
Saturday, Sunday and Statutory Holidays:
8 a.m. to 12 a.m. Eastern Time
FULL SET OF FORMS FOR PHARMACY PROVIDERS
NIHB
Pharmacy Claims Submission Kit - Quebec
NIHB
Pharmacy Claims Submission Kit Attachment
Quebec_Pharmacy_Provider_Information_Change_Request_Form
Quebec Pharmacy Provider Information Change Request Form (Sample)
NIHB
Pharmacy Claim Form
Provider Statement - Pharmacy (Sample)
Prior Approval Confirmation Letter (Sample)
ESI Canada Modification to Pharmacy - Medical Supplies and Equipment (MS&E) Information Form
Pharmacy Explanation Letter - Quebec
Pharmacy Expanation Letter - Quebec (Sample)
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