ESI Canada
ESI Canada
Redefining Health Claims Solutions  





Non-Insured Health Benefits (NIHB)
Pharmacy Provider Documentation

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

pdf icon FULL SET OF ALL REGISTRATION FORMS FOR PHARMACY PROVIDERS

pdf icon NIHB Pharmacy Claims Submission Kit

pdf icon NIHB Pharmacy Claims Submission Kit Attachment

pdf icon ESI Canada Pharmacy Provider Agreement

pdf icon ESI Canada Pharmacy Provider Agreement (Sample)

pdf icon NIHB Pharmacy Claim Form

pdf icon Provider Statement - Pharmacy (Sample)

pdf icon Prior Approval Confirmation Letter (Sample) 

pdf icon ESI Canada Modification to Pharmacy-Medical Supplies and Equipment (MS&E) Information Form




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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

pdf icon FULL SET OF FORMS FOR PHARMACY PROVIDERS

pdf icon NIHB Pharmacy Claims Submission Kit - Quebec

pdf icon NIHB Pharmacy Claims Submission Kit Attachment

pdf icon Quebec_Pharmacy_Provider_Information_Change_Request_Form

pdf icon Quebec Pharmacy Provider Information Change Request Form (Sample)

pdf icon NIHB Pharmacy Claim Form

pdf icon Provider Statement - Pharmacy (Sample)

pdf icon Prior Approval Confirmation Letter (Sample) 

pdf icon ESI Canada Modification to Pharmacy - Medical Supplies and Equipment (MS&E) Information Form

pdf icon Pharmacy Explanation Letter - Quebec

pdf icon Pharmacy Expanation Letter - Quebec (Sample)



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