MedicaidAdministrativeMedium impact
Newsletter Vol. 21, No.29
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
Effective date
Jan 15, 2012
We identified it
Jun 20, 2026
Summary
New Jersey pharmacy providers must annually complete and submit Form FD-70 (Pharmacy Provider Certification Statement) to qualify for optional dispensing fee increments ($0.15 impact allowance and $0.11 24-hour emergency service). Providers must certify eligibility criteria and provide ownership disclosure. Failure to submit by the deadline results in automatic assignment of basic dispensing fee without increments.
Action Required
By January 15, 2012: Pharmacy providers participating in NJ FamilyCare/Medicaid, PAAD, Senior Gold, ADDP, or CF programs must complete Form FD-70 in full with all questions answered and attach a copy of valid pharmacy permit. Submit to Molina Medicaid Solutions, P.O. Box 4804, Trenton, NJ 08650-4804, Attn: Form FD-70. Incomplete forms will be returned. If not submitted by deadline, the State will automatically assign only basic dispensing fee without optional increments ($0.15 impact allowance and $0.11 24-hour emergency service fee). Providers must also notify Molina Medicaid Solutions within 30 days of any changes to impact allowance eligibility and within 72 hours of discontinuing 24-hour emergency service.