Pharmacy Account Management

What do you want to do?

New Pharmacy

This is your PBC-assigned 10 digit ID number, i.e.: BC00000A##
License Information
Upload a copy (.pdf, .png, .gif, .jpg) of your business operating license. Max 2MB.
Pay-Direct Transmission Information (BC and YT only)

This information is required to enable Pay-Direct claim transmission. Ask your software vendor if you are unsure of your IP address.

If more than one computer terminal, enter your usable LAN IP range

Please note that IP addresses that fall within the following ranges are reserved for internal networks only and will not transmit to PBC:

10.0.0.0 - 10.255.255.255
172.16.0.0 - 172.31.255.255
192.168.0.0 - 192.168.255.255

For WinRx: Please provide IP address connected to the Pharmanet system router.
For Kroll: Please provide IP address defined as External IP under Kroll Connect.

Please ensure that your software vendor has correctly configured your connection.

Pharmacy Information

Updated Pharmacy Information
Pharmacy Primary Administrator for PROVIDERnet

Role of PROVIDERnet Primary Administrator

  • Self-serve access to set up, change, view banking information for direct deposit.
  • Can view electronic statements
  • Create new "Standard" or other "Primary" administrators if you choose to delegate to an office manager. A "Standard Administrator" has "view only" access for electronic statements and no access to banking information.

Email Address Guidelines

  • Since a Primary Administrator has full access to view and change banking information as well as create other Primary Administrators, we discourage using a multi-user or communal pharmacy email address, e.g. admin@pharmacyname.com.
  • The Primary Administrator is usually the pharmacy owner or director of business

This will be the login for PROVIDERnet
Additional Comments
Signature
By checking this box, I confirm that the information in this application is true and accurate. I agree to notify Pacific Blue Cross (PBC) of any change in pharmacy manager, owner or legal name in the event of a change in ownership or Director of Business. Violation of any Pacific Blue Cross policy, noncompliance of any Pharmacy Agreement, or PBC Pharmacy Reference Guide, will result in the cancellation of the provider number.
Person filling in this application