MedicaidAdministrativeLow impact
Newsletter Vol. 19, No. 58
New Jersey Medicaid·NJ·Provider Notice
Effective date
Jan 15, 2010
We identified it
Jun 20, 2026
Summary
New Jersey pharmacy providers must submit Form FD-70 (Pharmacy Provider Certification Statement) by January 15, 2010 to qualify for optional dispensing fee increments for NJ FamilyCare/Medicaid, PAAD, Senior Gold, ADDP, and CF programs. Failure to submit will result in basic dispensing fees only.
Action Required
By January 15, 2010: New Jersey pharmacy providers must complete and submit Form FD-70 (Pharmacy Provider Certification Statement) with a copy of valid pharmacy permit to Unisys at P.O. Box 4804, Trenton, NJ 08650-4804. All questions must be completed or forms will be returned. Failure to submit will result in automatic assignment of basic dispensing fees without optional increments ($0.15 impact allowance and $0.11 24-hour emergency service fee).