MedicaidAdministrativeMedium impact
Newsletter Vol. 16, No. 16
New Jersey Medicaid·NJ · Pharmacy·Provider Notice
Effective date
Dec 15, 2006
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare pharmacy providers must submit a completed Form FD-70 Pharmacy Provider Certification Statement by December 15, 2006, to qualify for optional dispensing fee increments ($0.15 impact allowance, $0.11 for 24-hour emergency service, $0.08 for patient consultation). Providers who fail to submit will automatically receive only the basic dispensing fee without increments. This is a credentialing/compliance requirement for pharmacy providers in New Jersey.
Action Required
By December 15, 2006: Pharmacy providers participating in New Jersey Medicaid, NJ FamilyCare, PAAD, Senior Gold, ADDP, or CF programs must complete Form FD-70 in its entirety and mail it with a copy of their valid pharmacy permit to Unisys, P.O. Box 4804, Trenton, NJ 08650-4804. Incomplete forms will be returned. Providers must certify eligibility for fee increments (impact allowance requires ≥50% combined prescription volume; 24-hour emergency service requires availability 365 days/year with posted notification and local phone number; patient consultation requires PDUR compliance per N.J.A.C. 13:39-7.14 and OBRA 1993). Failure to submit by the deadline will result in automatic assignment of basic dispensing fee only, with no increments. Any changes to qualifying conditions must be reported to Unisys within 30 days (72 hours for 24-hour service discontinuation). All statements are subject to audit and potential retroactive recovery of overpayments.