MedicaidAdministrativeLow impact
Newsletter Vol. 23, No.01
New Jersey Medicaid·NJ·Provider Notice
Effective date
Jan 15, 2013
We identified it
Jun 20, 2026
Summary
New Jersey pharmacy providers must submit Form FD-70 by January 15, 2013 to qualify for optional dispensing fee increments ($0.15 impact allowance and $0.11 24-hour emergency service fee). Failure to submit will result in assignment of basic dispensing fee only.
Action Required
By January 15, 2013: New Jersey pharmacy providers must complete and submit Form FD-70 Pharmacy Provider Certification Statement with valid pharmacy permit to Molina Medicaid Solutions, P.O. Box 4804, Trenton, NJ 08650-4804. Include prescription volume data for impact allowance and 24-hour emergency service details. Incomplete forms will be returned and failure to submit will result in basic dispensing fee assignment without optional increments.