INNOVATIVE PRACTICE FORM

Name: Janice Bopp

Address: 426 N. Michigan St., South Bend, IN 46601

Phone #: 219-234-3184

FAX #: 219-289-1940

Briefly describe innovation

Presently completing a major store re-modeling to convert to pharmaceutical care. Specialty areas attempting to embark on: diabetes management; women's health and information center; asthma attack management.

Method of Reimbursement

Payor(s): Have attempted to bill-have not gotten paid by major medical indemnity plans

Reimbursement rate: Haven't decided-depends on third party or cash customer; $60 hour ?

Is documentation required? Yes Will document-haven't got software yet.

Specialized training required? Yes Enrolled in a pilot certificate program

Software/instrumentation required? No