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[null,"Invoicing Details Form"]
[null,"Please provide details of where the invoices for monthly prescribing costs (reimbursement) and dispensing fees (remuneration) should be sent for payment, including details the appropriate person within your organisation to receive these invoices. Once completed, please return this form to:"]
[null,"accountsreceivable@nhsbsa.nhs.uk"]
[null,"Section A - Billing Method"]
[null,"Billing Method (Please select one option for invoice delivery)"]
[]
[null,"Section B - Billing Details"]
[null,"If you have selected to receive your invoice by email, please detail the recipients below:"]
[null,"Name:"]
[null,"Job title:"]
[null,"Email address: "]
[]
[null,"Name:"]
[null,"Job title:"]
[null,"Email address: "]
[]
[null,"Name:"]
[null,"Job title:"]
[null,"Email address: "]
[]
[null,"Name:"]
[null,"Job title:"]
[null,"Email address: "]
[]
[null,"Name:"]
[null,"Job title:"]
[null,"Email address: "]
[]
[]
[null,"If you have selected to receive your invoice by post, please detail the recipients below:"]
[null,"Organisation Name:"]
[null,"Organisation Code:"]
[null,"Department responsible for payment:"]
[null,"For the attention of:"]
[null,"Full billing address:"]
[]
[null,"Contact name (in the event of any queries):"]
[null,"Contact telephone (in the event of any queries):"]
[]
[null,"Section C - Payment Queries"]
[null,"Name:"]
[null,"Job title:"]
[null,"Telephone Number:"]
[null,"Email address: "]
[]
[null,"Name:"]
[null,"Job title:"]
[null,"Telephone Number:"]
[null,"Email address: "]
[]
[null,"Name:"]
[null,"Job title:"]
[null,"Telephone Number:"]
[null,"Email address: "]
[]
[null,"Name:"]
[null,"Job title:"]
[null,"Telephone Number:"]
[null,"Email address: "]
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[]
[null,null,null,null,null,"Email (for sustainability reasons, this is our preferred method)"]
[null,null,null,null,null,"Post"]
[]
[]
[]
[null,null,null,null,null,"Prescribing",null,"Partner"]
[null,null,null,null,null,"Dispensing",null,"Salaried"]

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