Offer COVID-19 Tests,
       Earn Reimbursement

Why Partner with eTrueNorth to Offer COVID-19 Testing?

eTrueNorth offers a turnkey solution for pharmacies to offer laboratory-based PCR COVID-19 testing. eTrueNorth partners with independent pharmacies, small banners, and major national brands to provide testing in communities across all 50 states.

eTrueNorth provides:

• All key components to manage test registration, scheduling, specimen collection, laboratory testing and communication of test results
• Laboratory-based PCR COVID test kits, along with packaging required for collection and shipping supplies, which are sent to your pharmacy at no cost to you
• Online portal for patients to register for a test (www.IneedaCOVID19test.com)
• Results delivered to the participant and required government entities via a secure platform
• Access to our platform for your pharmacy team to see store-specific appointments and print lab requisition/vouchers for patients, if needed
• Virtual training and “How To Guide” to ensure a successful laboratory-based PCR COVID-19 testing program
• Detailed contract including per-test-completed reimbursement to your pharmacy
• Call center support for patients in need of help registering, accessing their account or retrieving results

It's Easy to Get Started:

• One single contract gives you access to participate in the eTrueNorth Network
• Individual statements of work allow you to easily expand program offerings such as:
• Laboratory-based PCR COVID-19 testing
• Employee wellness screenings such as A1c, lipid, and glucose testing
• Other Gap in Care Closure programs
• Reimbursement for services that are traditionally difficult to independently contract
• Laboratory-related compliance support:
• Services that ensure your pharmacy has a one-stop resource for all CLIA-waived regulatory compliance needs
• Easy-to-use, configurable set of CLIA-waived laboratory policies & procedures designed for quick and easy regulatory compliance

eTrueNorth Supports Reimbursement Models for Expanded Clinical Services

We support much more than laboratory-based PCR COVID-19 testing. Benefits to pharmacy partners include:

• New patient population access and growing pharmacy revenue
• Support to capture revenue by contracting with eTrueNorth for reimbursement for programs that require point-of-care testing
• Health plans contract with eTrueNorth to address gaps in care for plan members
• Employers contract with eTrueNorth to serve their Employee Wellness Screening Programs
• Disease-management companies contract with eTrueNorth to help track member progress
• Participating pharmacies perform the clinical service; eTrueNorth submits claim/invoice to our client
• eTrueNorth reimburses pharmacy partners for services provided

Let's Get Testing

It's a simple six-step process to offer laboratory-based PCR COVID-19 testing at your retail pharmacy:
STEP ONE: Complete the basic information form below
STEP TWO: Receive confirmation and invitation to join the network
STEP THREE: Review and sign contract
STEP FOUR: Submit information for reimbursement
STEP FIVE: Training
STEP SIX: Submit the days of week and times of day you will be offering testing at each location

We promise to work as quickly as possible to enable your retail pharmacy to begin testing!

All fields are required.

Number of pharmacy locations in your healthcare organization wishing to offer COVID testing:

Name of Pharmacy

Address

City

State

Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Zip

County/Parish

Name of Corporate Pharmacy Organization

Corporate Address

City

State

Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Zip

First Name of individual completing this form

Last Name of individual completing this form

Telephone of individual completing this form

Email of individual completing this form

Please reenter your email for verification

Pharmacies can do a laboratory-based COVID test without a CLIA. eTrueNorth also offers other point-of-care testing that requires a CLIA such as A1c and lipid/glucose.

Are you ONLY interested in PCR laboratory-based COVID testing?

Yes

No

If you would like to offer other laboratory point-of-care testing, you must provide your NPI and CLIA certificate numbers and expiration date.
Are you prepared to list this information now?

Yes

No

NPI #10 digit all numbers (e.g.: ##########)

CLIA #10 digit number format: (e.g.: ##A######)

CLIA Expiration Date

Would you like more information about how to obtain a CLIA for your pharmacy to allow you to offer other point-of-care tests?

Yes

No

Is your pharmacy part of one of the following organizations?

None of these - I am a new pharmacy to eTrueNorth Price Chopper/Market 32 Hartig Brookshire's Coborn's Weis SpartanNash/Family Fare Ridley's Pruett's Hy Vee HomeTown Ball's Food Stores Part of Topco but none of the above Fruth HealthMart Kinney Meijer

Did you hear about eTrueNorth COVID testing program from any of the following organizations?

ACA APhA Cardinal CPESN NASPA NCPA None of the above

Comments

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Has your pharmacy previously offered COVID testing?

Yes

No

Lastly, if eTrueNorth is able to partner with your pharmacy to provide testing, we will be sending you a contract for review that will formalize our relationship. While you input your contact information above, many times the signer on the contract may be a different person.

Please provide contact details for the person who has legal authority to sign contracts for your pharmacy:

First Name

Last Name

Address

City

State

Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Zip

Email of signer