Notify BWC when there's an issue with the availability of a generic in the marketplace or when the pharmacy provider believes the MAC price should be adjusted due to changes in marketplace pricing.

Fax the following information with supporting documentation to 614-621-1083.
* Supporting documentation includes, but is not limited to, recent drug purchase invoices and any other pertinent information you feel will be of assistance.

Your information
Name _______________________________
Phone number ________________________
Email address ________________________

Store information
NPI# ________________________________
Store/Chain name ______________________
City _________________________________
ZIP code _____________________________

Drug information
Product description _____________________
NDC# _______________________________
Pharmacy Purchase Price per unit _________
Date of service ________________________

Inquiry (Please check the appropriate field.)
Product availability ____________________
MAC price ___________________________

For additional assistance or to obtain the status of an inquiry, call 877-543-6446.