Pharmacy
For Pharmacy forms, please go to our Forms page.
- VA Medicaid 90-Day Drug List Update
- Preferred Drug List
- Drug Recalls
- Molina Specialty Pharmacy Program
- Pharmacists as Providers
According to Senate Bill 1538 (S.B. 1538) requires Virginia Medicaid including Medicaid Managed Care Organizations to reimburse pharmacists for any service provided under a collaborative agreement or statewide protocol.
Below are the steps for Pharmacists to get credentialed and contracted with Molina Healthcare (MHI).
- Pharmacists must first enroll with Virginia Medicaid as a provider through the Provider Services Solution (PRSS) portal at https://virginia.hppcloud.com/.
- Once enrolled with Virginia Medicaid, send an email to Molina Healthcare Provider Network team at MolinaVA.ProviderInquiry@MolinaHealthcare.com and request to start the contracting and credentialing process with Molina Healthcare (MHI).
- MHI will send you the required documentation to be completed which also may be accessed at https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/va/Forms/VA-ALL-PF-11460-22-VA-Guide-to-Prv-Forms-FINAL_508c.pdf.
- Provider Information Update Form (Section A only for new providers)
- W9
- Attachment D: Services Provided Virginia
- Americans with Disabilities act (ADA) Form: Virginia
- You will also need to register with CAQH Proview at https://proview.caqh.org/pr and complete all profile questions to register. Please indicate that you are authorized to access Molina Healthcare data.
- Please submit the required documentation in #3 to MolinaVA.ProviderInquiry@MolinaHealthcare.com.
- Once all the required documentation is submitted, MHI will send a provider contract for execution and return to MHI.
- Once contracting and credentialling approved by MHI, the MHI Provider Relations will outreach you to arrange provider orientation.
- Pharmacist can submit claims to MHI.
Pharmacist Billing Information
- Vaccine Information