NYS Medicaid Forms & Manuals

NYS Medicaid PDP Information:

• Click Here for pages 8 & 9 of the NYS DOH Medicaid Update explaining the Medicaid Preferred Drug Program
• Click Here for the First Health NYS Preferred Drug Program Home Page
• Click Here for the NYS Medicaid Preferred Drug List
• PDP Prior Authorization Forms/Worksheets

From EMedNY

• SMAC Research Request Form

• Click Here for the Medicaid Pharmacy Enrollment Packet - pages 17-20 are the Medicaid Enrollment: Supervising Pharmacist Form (emedny-409701) and instructions - please read the instructions on pages 17 & 18 carefully as some of the requirements have changed!!!

• Please be advised that eMedNY has posted the EFT Enrollment Form with accompanying instructions on their www.emedny.org website. Just go to 'Featured Links' and click on 'Provider Enrollment Forms'. The EFT Enrollment information is under 'Provider Maintenance Forms', toward the bottom. Or Click Here.
  
• Located here is the OTC price list for Medicaid
  
• Supervising Pharmacist Agreement

• Pharmacy Enrollment Packet (includes both Supervising Pharmacist Agreement & Supervising RPh Medicaid Provider Enrollment Form
  
• NPI Information • NPI Paper Application • NPI Electronic Application
  
• Info for All Providers - Includes:
• Introduction
• General Policy
• Inquiry
• Third Party Information