MCO_PLAN_CD|MCO_FULL_NM|MCO_SERVICE_AREA|MCO_PLAN_EFF_DT|MCO_PLAN_TERM_DT|MCO_PGM|MCO_PBM_NAME|MCO_PLAN_RX_NUM|MCO_PLAN_PCN|MCO_PLAN_GRP|MCO_NOTE|MCO_PHARM_ENROLL_PH_NUM|MCO_PHARM_ENROLL_PH_EXT|MCO_PHARM_ENROLL_FAX_NUM|MCO_PHARM_ENROLL_EMAIL|MCO_PHARM_ENROLL_WEB|MCO_DME_ENROLL_PH_NUM|MCO_DME_ENROLL_PH_EXT|MCO_DME_ENROLL_FAX_NUM|MCO_DME_ENROLL_EMAIL|MCO_DME_ENROLL_WEB|MCO_PHARM_PH_NUM|MCO_PHARM_PH_EXT|MCO_PA_PH_NUM|MCO_PA_PH_EXT|MCO_MEMBER_PH_NUM|MCO_MEMBER_PH_NUM_EXT|MCO_CPA_WEB|MCO_C_PBM_EFF_DT|MCO_PHARM_PDL_WEB|MCO_PHARM_MANUAL_WEB|MCO_PHARM_PAYER_SHEETS_WEB|MCO_PHARM_FORMS_WEB|MCO_FORMULARY_WEB
02|El Paso Health|El Paso|03/01/2012|08/31/2024|CHIP|Navitus|610602|MCD|EPH||6082985775||6082985875|providerrelations@navitus.com||8775323778|1018||||||8779086023||8775323778||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
03|Community First Health Plan|Bexar|03/01/2012|08/31/2024|CHIP|Navitus|610602|MCD|CFG||6082985775||6082985875|providerrelations@navitus.com|Navitus.com|6082985775|||providerrelations@navitus.com||||8779086023||8004342347||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
04|Cook Children's Health Plan|Tarrant|03/01/2012|08/31/2024|CHIP|Navitus|610602|MCD|CCH||6087291577||9207355351|providerrelations@navitus.com||6828852247|||||||8779086023||8009642247||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
05|Driscoll Childrens Health Plan|Nueces|03/01/2012|08/31/2024|CHIP|Navitus|610602|MCD|DCH||6082985775||6082985875|providerrelations@navitus.com||8774515598|||donald.well@dchstx.org||||8779086023||8774515598||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
06|FirstCare|Lubbock|03/01/2012|08/31/2024|CHIP|Navitus|610602|MCD|FCH||6082985775||6082985875|providerrelations@navitus.com||8002644111|||||||8779086023||8004317798||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
09|Parkland Health Plan|Dallas|03/01/2012|08/31/2024|CHIP|Navitus|610602|MCD|PHC||6082985775||6082985776|providerrelations@navitus.com|||||||8779086023||8779086023||8888142352||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
10|Superior Health Plan|Travis|03/01/2012|08/31/2024|STAR|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8007835386||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
18|UnitedHealthcare|Travis|03/01/2012|08/31/2024|STAR+PLUS|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|||8778423210|||||||8003106826||8888879003||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
19|Amerigroup Texas, Inc.|Travis|03/01/2012|08/31/2024|STAR+PLUS|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
1A|Dell Children's Health Plan|Travis|03/01/2012|08/31/2024|STAR|Navitus|610602|MCD|SHP||6087291577||9207355351|providerrelations@navitus.com||5123243125|||||||8779086023||8885960268||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
1B|Superior Health Plan|Travis|03/01/2012|08/31/2024|CHIP|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8007835386||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
1E|Superior Health Plan|Statewide|09/01/2016|08/31/2028|STARHEALTH|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8669126283||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
1F|Molina Healthcare of Texas|Statewide|09/01/2010|08/31/2024|CHIP|CVS/Caremark|004336|ADV|RX0824||8778743317||||www.caremark.com/pharminfo|8553224080|||TexasExpansionContracting@MolinaHealthcare.com||||8553224080||8664496849||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
1H|MCNA|CHIP RSA|03/01/2012|08/31/2024|Dental||||||||||||||||||||||||||||
1J|MCNA|STATEWIDE|03/01/2012|08/31/2024|Dental||||||||||||||||||||||||||||
1K|DentaQuest|CHIP RSA|03/01/2012|08/31/2024|Dental||||||||||||||||||||||||||||
1M|DentaQuest|STATEWIDE|03/01/2012|08/31/2024|Dental||||||||||||||||||||||||||||
1P|Blue Cross Blue Shield|Travis|03/01/2012|08/31/2024|STAR|Prime Therapeutics|11552|TXCAID|TXS1, TXS2||8882775510||8778236373|Pharmacyops@primetherapeutics.com|primetherapeutics.com/pharmacist.html|9727662699|||bcbstxancillarycontracting@bcbstx.com||||8554570407||8886576061||https://www.bcbstx.com/provider/medicaid/pharmacy/clinical-e||||||
1Q|Blue Cross Blue Shield|Travis|03/01/2012|08/31/2024|CHIP|Prime Therapeutics|11552|TXCAID|TXC1, TXC2, TXC3, TXC4, TXC5, TXC6, TXC7||8882775510||8778236373|Pharmacyops@primetherapeutics.com|primetherapeutics.com/pharmacist.html|9727662699|||bcbstxancillarycontracting@bcbstx.com||||8554570407||8886576061||https://www.bcbstx.com/provider/medicaid/pharmacy/clinical-e||||||
1R|UHC Dental|Statewide|09/01/2020|12/31/2078|CMDS||||||||||||||||||||||||||||
1S|UHC Dental|Statewide|09/01/2020|12/31/2078|DMO||||||||||||||||||||||||||||
2Q|UnitedHealthcare|Nueces|03/01/2012|08/31/2024|STAR|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|||8778423210|||||||8003106826||8888879003||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
2R|UnitedHealthcare|Nueces|03/01/2012|08/31/2024|CHIP|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|||8778423210|||||8773058952||8003106826||8888879003||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
31|Molina Healthcare of Texas|El Paso|03/01/2012|08/31/2024|STAR|CVS/Caremark|004336|ADV|RX0825||8778743317||||www.caremark.com/pharminfo|8553224080|||TexasExpansionContracting@MolinaHealthcare.com||||8553224080||8664496849||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
33|Molina Healthcare of Texas|El Paso|03/01/2012|08/31/2024|STAR+PLUS|CVS/Caremark|004336|ADV|RX0826||8778743317||||www.caremark.com/pharminfo|8553224080|||TexasExpansionContracting@MolinaHealthcare.com||||8553224080||8664496849||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
34|Amerigroup Texas, Inc.|El Paso|03/01/2012|08/31/2024|STAR+PLUS|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
36|Superior Health Plan|El Paso|03/01/2012|08/31/2024|STAR|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8007835386||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
37|El Paso Health|El Paso|03/01/2012|08/31/2024|STAR|Navitus|610602|MCD|EPH||6082985775||6082985875|providerrelations@navitus.com||8775323778|1018||||||8779086023||8775323778||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
39|Superior Health Plan|El Paso|03/01/2012|08/31/2024|CHIP|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8007835386||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
40|Superior Health Plan|Bexar|03/01/2012|08/31/2024|STAR|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8007835386||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
42|Community First Health Plan|Bexar|03/01/2012|08/31/2024|STAR|Navitus|610602|MCD|CFG||6082985775||6082985875|providerrelations@navitus.com||6082985775|||providerrelations@navitus.com||||8779086023||8004342347||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
43|Aetna|Bexar|03/01/2012|08/31/2024|STAR|CVS/Caremark|610591|ADV|RX8801||||||cvs.az1.qualtrics.com/jfe/form/SV_8B0YUouguzbheAJ?Q_JFE=qdg||||||||8002487767||8002487767||www.aetnabetterhealth.com/texas/providers/pharmacy/prior-aut|07/01/2012|||||
44|Amerigroup Texas, Inc.|Bexar|03/01/2012|08/31/2024|STAR|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
45|Amerigroup Texas, Inc.|Bexar|03/01/2012|08/31/2024|STAR+PLUS|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
46|Molina Healthcare of Texas|Bexar|03/01/2012|08/31/2024|STAR+PLUS|CVS/Caremark|004336|ADV|RX0826||8778743317||||www.caremark.com/pharminfo|8553224080|||TexasExpansionContracting@MolinaHelathcare.com||||8553224080||8664496849||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
47|Superior Health Plan|Bexar|03/01/2012|08/31/2024|STAR+PLUS|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8772779772||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
48|Superior Health Plan|Bexar|03/01/2012|08/31/2024|CHIP|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8007835386||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
49|Aetna|Bexar|03/01/2012|08/31/2024|CHIP|CVS/Caremark|610591|ADV|RX8801||||||cvs.az1.qualtrics.com/jfe/form/SV_8B0YUouguzbheAJ?Q_JFE=qdg|8668180959|||||||8668180959||8668180959||www.aetnabetterhealth.com/texas/providers/pharmacy/prior-aut|07/01/2012|||||
4C|Amerigroup Texas, Inc.|Bexar|03/01/2012|08/31/2024|CHIP|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME|7132185112|||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
50|FirstCare|Lubbock|03/01/2012|08/31/2024|STAR|Navitus|610602|MCD|FCH||6082985775||6082985875|providerrelations@navitus.com||8002644111|||||||8779086023||8004317798||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
52|Superior Health Plan|Lubbock|03/01/2012|08/31/2024|STAR|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8007835386||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
53|Amerigroup Texas, Inc.|Lubbock|03/01/2012|08/31/2024|STAR|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
56|Dell Children's Health Plan|Travis|03/01/2012|08/31/2024|CHIP|Navitus|610602|MCD|SHP||6087291577||9207355351|providerrelations@navitus.com||5123243125|||||||8779086023||8885960268||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
57|Superior Health Plan|Lubbock|03/01/2012|08/31/2024|CHIP|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8007835386||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
59|Superior Health Plan|Statewide|09/01/2010|08/31/2024|CHIP|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8007835386|||01/01/2024||h|h|h|
5A|Amerigroup Texas, Inc.|Lubbock|03/01/2012|08/31/2024|STAR+PLUS|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
5B|Superior Health Plan|Lubbock|03/01/2012|08/31/2024|STAR+PLUS|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8772779772||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
63|Amerigroup Texas, Inc.|Tarrant|03/01/2012|08/31/2024|STAR|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
66|Cook Children's Health Plan|Tarrant|03/01/2012|08/31/2024|STAR|Navitus|610602|MCD|CCH||6087291577||9207355351|providerrelations@navitus.com||6828852247|||||||8779086023||8009642247||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
67|Aetna|Tarrant|03/01/2012|08/31/2024|STAR|CVS/Caremark|610591|ADV|RX8801||||||cvs.az1.qualtrics.com/jfe/form/SV_8B0YUouguzbheAJ?Q_JFE=qdg||||||||8003068612||8003068612||www.aetnabetterhealth.com/texas/providers/pharmacy/prior-aut|07/01/2012|||||
69|Amerigroup Texas, Inc.|Tarrant Exp.|03/01/2012|08/31/2024|STAR+PLUS|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
6A|Amerigroup Texas, Inc.|Tarrant|03/01/2012|08/31/2024|CHIP|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
6B|Aetna|Tarrant|03/01/2012|08/31/2024|CHIP|CVS/Caremark|610591|ADV|RX8801||||||cvs.az1.qualtrics.com/jfe/form/SV_8B0YUouguzbheAJ?Q_JFE=qdg||||||||8002455380||8002455380||www.aetnabetterhealth.com/texas/providers/pharmacy/prior-aut|07/01/2012|||||
71|Amerigroup Texas, Inc.|Harris|03/01/2012|08/31/2024|STAR|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
72|Texas Children's Health Plan|Harris|03/01/2012|08/31/2024|STAR|Navitus|610602|MCD|TCH||6082985775||6082985875|providerrelations@navitus.com||8328258750|||||||8779086023||8669592555||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
79|Community Health Choice|Harris|03/01/2012|08/31/2024|STAR|Navitus|610602|MCD|CHC||6087291577||9207355351|providerrelations@navitus.com||8887602600|||||||8779086023||8887602600||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
7G|Molina Healthcare of Texas|Harris|03/01/2012|08/31/2024|STAR|CVS/Caremark|004336|ADV|RX0825||8778743317||||www.caremark.com/pharminfo|8553224080|||TexasExpansionContracting@MolinaHealthcare.com||||8553224080||8664496849||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
7H|UnitedHealthcare|Harris|03/01/2012|08/31/2024|STAR|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|||8778423210|||||||8003106826||8888879003||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
7M|Texas Children's Health Plan|Harris|03/01/2012|08/31/2024|CHIP|Navitus|610602|MCD|TCH||6082985775||6082985875|providerrelations@navitus.com||8328258750|||||||8779086023||8669592555||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
7N|Amerigroup Texas, Inc.|Harris|03/01/2012|08/31/2024|CHIP|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
7P|Amerigroup Texas, Inc.|Harris|03/01/2012|08/31/2024|STAR+PLUS|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
7R|UnitedHealthcare|Harris|03/01/2012|08/31/2024|STAR+PLUS|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|||8778423210|||||||8003106826||8888879003||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
7S|Molina Healthcare of Texas|Harris|03/01/2012|08/31/2024|STAR+PLUS|CVS/Caremark|004336|ADV|RX0826||8778743317||||www.caremark.com/pharminfo|8553224080|||TexasExpansionContracting@MolinaHealthcare.com||||8553224080||8664496849||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
7T|Molina Healthcare of Texas|Harris|03/01/2012|08/31/2024|CHIP|CVS/Caremark|004336|ADV|RX0824||8778743317||||www.caremark.com/pharminfo|8553224080|||TexasExpansionContracting@MolinaHealthcare.com||||8553224080||8664496849||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
7W|UnitedHealthcare|Harris|03/01/2012|08/31/2024|CHIP|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|||8778423210|||||8773058952||8003106826||8888879003||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
7Y|Community Health Choice|Harris|03/01/2012|08/31/2024|CHIP|Navitus|610602|MCD|CHC||6087291577||9207355351|providerrelations@navitus.com||8887602600|||||||8779086023||8887602600||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
82|Driscoll Childrens Health Plan|Nueces|03/01/2012|08/31/2024|STAR|Navitus|610602|MCD|DCH||6082985775||6082985875|providerrelations@navitus.com||8772206376|||donald.well@dchstx.org||||8779086023||8772206376||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
83|Superior Health Plan|Nueces|03/01/2012|08/31/2024|STAR|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8007835386||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
85|UnitedHealthcare|Nueces|03/01/2012|08/31/2024|STAR+PLUS|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|||8778423210|||||||8003106826||8888879003||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
86|Superior Health Plan|Nueces|03/01/2012|08/31/2024|STAR+PLUS|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8772779772||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
87|Superior Health Plan|Nueces|03/01/2012|08/31/2024|CHIP|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8007835386||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
8G|Amerigroup Texas, Inc.|Jefferson|03/01/2012|08/31/2024|STAR|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
8H|Community Health Choice|Jefferson|03/01/2012|08/31/2024|STAR|Navitus|610602|MCD|CHC||6087291577||9207355351|providerrelations@navitus.com||8887602600|||||||8779086023||8887602600||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
8J|Molina Healthcare of Texas|Jefferson|03/01/2012|08/31/2024|STAR|CVS/Caremark|004336|ADV|RX0825||8778743317||||www.caremark.com/pharminfo|8553224080|||TexasExpansionContracting@MolinaHealthcare.com||||8553224080||8664496849||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
8K|Texas Children's Health Plan|Jefferson|03/01/2012|08/31/2024|STAR|Navitus|610602|MCD|TCH||6082985775||6082985875|providerrelations@navitus.com||8328258750|||||||8779086023||8669592555||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
8L|UnitedHealthcare|Jefferson|03/01/2012|08/31/2024|STAR|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|||8778423210|||||||8003106826||8888879003||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
8R|Amerigroup Texas, Inc.|Jefferson|03/01/2012|08/31/2024|STAR+PLUS|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
8S|UnitedHealthcare|Jefferson|03/01/2012|08/31/2024|STAR+PLUS|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|||8778423210|||||||8003106826||8888879003||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
8T|Molina Healthcare of Texas|Jefferson|03/01/2012|08/31/2024|STAR+PLUS|CVS/Caremark|004336|ADV|RX0826||8778743317||||www.caremark.com/pharminfo|8553224080|||TexasExpansionContracting@MolinaHealthcare.com||||8553224080||8664496849||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
8U|Amerigroup Texas, Inc.|Jefferson|03/01/2012|08/31/2024|CHIP|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
8V|Community Health Choice|Jefferson|03/01/2012|08/31/2024|CHIP|Navitus|610602|MCD|CHC||6087291577||9207355351|providerrelations@navitus.com||8887602600|||||||8779086023||8887602600||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
8W|Molina Healthcare of Texas|Jefferson|03/01/2012|08/31/2024|CHIP|CVS/Caremark|004336|ADV|RX0824||8778743317||||www.caremark.com/pharminfo|8553224080|||TexasExpansionContracting@MolinaHealthcare.com||||8553224080||8664496849||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
8X|Texas Children's Health Plan|Jefferson|03/01/2012|08/31/2024|CHIP|Navitus|610602|MCD|TCH||6082985775||6082985875|providerrelations@navitus.com||8328258750|||||||8779086023||8669592555||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
8Y|UnitedHealthcare|Jefferson|03/01/2012|08/31/2024|CHIP|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|||8778423210|||||8773058952||8003106826||8888879003||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
90|Amerigroup Texas, Inc.|Dallas|03/01/2012|08/31/2024|STAR|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
93|Parkland Health Plan|Dallas|03/01/2012|08/31/2024|STAR|Navitus|610602|MCD|PHS||6082985775||6082985876|providerrelations@navitus.com|||||||8779086023||8779086023||8888142352||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
95|Molina Healthcare of Texas|Dallas|03/01/2012|08/31/2024|STAR|CVS/Caremark|004336|ADV|RX0825||8778743317||||www.caremark.com/pharminfo|8553224080|||TexasExpansionContracting@MolinaHealthcare.com||||8553224080||8664496849||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
9A|Amerigroup Texas, Inc.|Dallas|03/01/2012|08/31/2024|CHIP|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
9C|Molina Healthcare of Texas|Dallas|03/01/2012|08/31/2024|CHIP|CVS/Caremark|004336|ADV|RX0824||8778743317||||www.caremark.com/pharminfo|8553224080|||TexasExpansionContracting@MolinaHealthcare.com||||8553224080||8664496849||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
9F|Molina Healthcare of Texas|Dallas Exp.|03/01/2012|08/31/2024|STAR+PLUS|CVS/Caremark|004336|ADV|RX0826||8778743317||||www.caremark.com/pharminfo|8553224080|||TexasExpansionContracting@MolinaHealthcare.com||||8553224080||8664496849||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
9H|Superior Health Plan|Dallas Exp.|03/01/2012|08/31/2024|STAR+PLUS|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8772779772||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
C1|Amerigroup Texas, Inc.|MRSA Central|03/01/2012|08/31/2024|STAR|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
C2|Superior Health Plan|MRSA Central|03/01/2012|08/31/2024|STAR|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8007835386||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
C3|Scott & White|MRSA Central|03/01/2012|08/31/2024|STAR|Navitus|610602|MCD|SWH||6082985775||6082985875|providerrelations@navitus.com||2542983064|||||||8779086023||8558974448||https://rightcare.swhp.org/en-us/prov/authorizations||||||
C4|Superior Health Plan|MRSA Central|09/01/2014|08/31/2024|STAR+PLUS|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8772779772||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
C5|UnitedHealthcare|MRSA Central|09/01/2014|08/31/2024|STAR+PLUS|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|||8778423210|||||||8003106826||8888879003||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
H1|UnitedHealthcare|Hidalgo|03/01/2012|08/31/2024|STAR|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|||8778423210|||||||8003106826||8888879003||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
H2|Superior Health Plan|Hidalgo|03/01/2012|08/31/2024|STAR|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8007835386||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
H3|Molina Healthcare of Texas|Hidalgo|03/01/2012|08/31/2024|STAR|CVS/Caremark|004336|ADV|RX0825||8778743317||||www.caremark.com/pharminfo|8553224080|||TexasExpansionContracting@MolinaHealthcare.com||||8553224080||8664496849||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
H4|Driscoll Childrens Health Plan|Hidalgo|03/01/2012|08/31/2024|STAR|Navitus|610602|MCD|DCH||6082985775||6082985875|providerrelations@navitus.com||8554253247|||donald.well@dchstx.org||||8779086023||8554253247||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
H5|Superior Health Plan|Hidalgo|03/01/2012|08/31/2024|STAR+PLUS|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8772779772||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
H6|Molina Healthcare of Texas|Hidalgo|03/01/2012|08/31/2024|STAR+PLUS|CVS/Caremark|004336|ADV|RX0826||8778743317||||www.caremark.com/pharminfo|8553224080|||TexasExpansionContracting@MolinaHealthcare.com||||8553224080||8664496849||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
K1|Aetna|Tarrant|11/01/2016|08/31/2024|STARKids|CVS/Caremark|610591|ADV|RX8801||||||cvs.az1.qualtrics.com/jfe/form/SV_8B0YUouguzbheAJ?Q_JFE=qdg||||||||8447875437||8447875437||www.aetnabetterhealth.com/texas/providers/pharmacy/prior-aut|07/01/2012|||||
K2|Amerigroup Texas, Inc.|Dallas|11/01/2016|08/31/2024|STARKids|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004243730||8333707463||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
K3|Amerigroup Texas, Inc.|El Paso|11/01/2016|08/31/2024|STARKids|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004243730||8333707463||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
K4|Amerigroup Texas, Inc.|Harris|11/01/2016|08/31/2024|STARKids|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004243730||8333707463||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
K5|Amerigroup Texas, Inc.|Lubbock|11/01/2016|08/31/2024|STARKids|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004243730||8333707463||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
K6|Amerigroup Texas, Inc.|MRSA West|11/01/2016|08/31/2024|STARKids|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004243730||8333707463||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
K7|Blue Cross Blue Shield|MRSA Central|11/01/2016|08/31/2024|STARKids|Prime Therapeutics|011552|TXCAID|600D, 600N, 601D, 601N, 602D, 602N, 603D, 603N, 604D, 604N,||8882775510||8778236373|Pharmacyops@primetherapeutics.com|primetherapeutics.com/pharmacist.html|9727662699|||bcbxtxancillarycontracting@bcbstx.com||||8554571200||8776881811||https://www.bcbstx.com/provider/medicaid/pharmacy/clinical-e||||||
K8|Blue Cross Blue Shield|Travis|11/01/2016|08/31/2024|STARKids|Prime Therapeutics|011552|TXCAID|600D, 600N, 601D, 601N, 602D, 602N, 603D, 603N, 604D, 604N,||8882775510||8778236373|Pharmacyops@primetherapeutics.com|primetherapeutics.com/pharmacist.html|9727662699|||bcbstxancillarycontracting@bcbstx.com||||8554571200||8776881811||https://www.bcbstx.com/provider/medicaid/pharmacy/clinical-e||||||
KA|Community First Health Plan|Bexar|11/01/2016|08/31/2024|STARKids|Navitus|610602|MCD|CFG||6082985775||6082985875|providerrelations@navitus.com|Navitus.com|6082985775|||providerrelations@navitus.com||||8779086023||8556077827||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
KB|Cook Children's Health Plan|Tarrant|11/01/2016|08/31/2024|STARKids|Navitus|610602|MCD|CCK||6087291577||9207355351|providerrelations@navitus.com||6828852247|||||||8779086023||8448430004||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
KC|Driscoll Childrens Health Plan|Hidalgo|11/01/2016|08/31/2024|STARKids|Navitus|610602|MCD|DCSK||6082985775||6082985875|providerrelations@navitus.com||8445084674|||donald.well@dchstx.org||||8779086023||8445084672||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
KD|Driscoll Childrens Health Plan|Nueces|11/01/2016|08/31/2024|STARKids|Navitus|610602|MCD|DCSK||6082985775||6082985875|providerrelations@navitus.com||8445084672|||donald.well@dchstx.org||||8779086023||8445084672||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
KE|Superior Health Plan|Bexar|11/01/2016|08/31/2024|STARKids|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8445904883||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
KF|Superior Health Plan|El Paso|11/01/2016|08/31/2024|STARKids|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8445904883||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
KG|Superior Health Plan|Hidalgo|11/01/2016|08/31/2024|STARKids|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8445904883||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
KH|Superior Health Plan|Lubbock|11/01/2016|08/31/2024|STARKids|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8445904883||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
KJ|Superior Health Plan|MRSA West|11/01/2016|08/31/2024|STARKids|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8445904883||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
KL|Superior Health Plan|Travis|11/01/2016|08/31/2024|STARKids|Express Scripts|003858|MA|2FDA||||||https://www.esiprovider.com/||||||8337504508|||||||01/01/2024||h|h|h|
KM|Texas Children's Health Plan|Harris|11/01/2016|08/31/2024|STARKids|Navitus|610602|MCD|TCHSK||6082985775||6082985875|providerrelations@navitus.com||8328281063|||||||8779086023||8006595764||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
KN|Texas Children's Health Plan|Jefferson|11/01/2016|08/31/2024|STARKids|Navitus|610602|MCD|TCHSK||6082985775||6082985875|providerrelations@navitus.com||8328281063|||||||8779086023||8006595764||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
KP|Texas Children's Health Plan|MRSA Northeast|11/01/2016|08/31/2024|STARKids|Navitus|610602|MCD|TCHSK||6082985775||6082985875|providerrelations@navitus.com||8328281063|||||||8779086023||8006595764||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
KQ|UnitedHealthcare|Harris|11/01/2016|08/31/2024|STARKids|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|pharmacycontracts@optum.com|Optumrx.com|8778423210|||||8773058952||8003106826||8775977799||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
KR|UnitedHealthcare|Hidalgo|11/01/2016|08/31/2024|STARKids|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|pharmacycontracts@optum.com||8778423210|||||8773058952||8003106826||8775977799||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
KS|UnitedHealthcare|Jefferson|11/01/2016|08/31/2024|STARKids|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|pharmacycontracts@optum.com||8778423210|||||8773058952||8003106826||8775977799||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
KT|UnitedHealthcare|MRSA Central|11/01/2016|08/31/2024|STARKids|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|pharmacycontracts@optum.com||8778423210|||||||8003106826||8775977799||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
KU|UnitedHealthcare|MRSA Northeast|11/01/2016|08/31/2024|STARKids|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|pharmacycontracts@optum.com||8778423210|||||||8003106826||8775977799||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
KV|Superior Health Plan|Nueces|11/01/2016|08/31/2024|STARKids|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8445904883||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
KW|Aetna|Dallas|09/01/2020|08/31/2024|STARKids|CVS/Caremark|610591|ADV|RX8801||||||cvs.az1.qualtrics.com/jfe/form/SV_8B0YUouguzbheAJ?Q_JFE=qdg||||||8778743317||8447875437||8447875437||www.aetnabetterhealth.com/texas/providers/pharmacy/prior-aut|07/01/2012|||||
N1|Amerigroup Texas, Inc.|MRSA Northeast|03/01/2012|08/31/2024|STAR|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
N2|Superior Health Plan|MRSA Northeast|03/01/2012|08/31/2024|STAR|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8007835386||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
N4|UnitedHealthcare|MRSA Northeast|09/01/2014|08/31/2024|STAR+PLUS|Optum Rx|610494|4400|ACUTX||8006133591||8668114224|||8778423210|||||||8003106826||8888879003||https://www.uhcprovider.com/en/health-plans-by-state/texas-h||||||
P1|Molina Healthcare of Texas|Tarrant|01/01/2022|08/31/2024|STAR+PLUS|CVS/Caremark|004336|ADV|RX0826||8778743317||||https://cvs.az1.qualtrics.com/jfe/form/SV_8B0YUouguzbheAJ?Q_|8553224080|||MHTContractRequest@MolinaHealthCare.com||8778743317||8553224080||8664496849||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
P2|Molina Healthcare of Texas|Tarrant|01/01/2022|08/31/2024|STAR+PLUS|Express Scripts|610014|MEDDPRIME|MOLMMPX|||||NetworkCompliance@express-scripts.com|||||NetworkCompliance@express-scripts.com||8665443801||8668568699||8009356103||https://www.molinahealthcare.com/providers/tx/medicaid/drug/|01/01/2022|||||
P3|Molina Healthcare of Texas|MRSA Northeast|01/01/2022|08/31/2024|STAR+PLUS MMP|CVS/Caremark|004336|ADV|RX0826||8778743317||||https://cvs.az1.qualtrics.com/jfe/form/SV_8B0YUouguzbheAJ?Q_|8553224080|||MHTContractRequest@MolinaHealthCare.com||8778743317||8664496849||8553224080||https://www.molinahealthcare.com/providers/tx/medicaid/drug/||||||
W2|Amerigroup Texas, Inc.|MRSA West|03/01/2012|08/31/2024|STAR|CarelonRx|020107|CS|WKEA||8664884708||||www.caremark.com/wps/portal/FOR_HEALT_PROS_HOME||||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
W3|Superior Health Plan|MRSA West|03/01/2012|08/31/2024|STAR|Express Scripts|003858|MA|2FDA||8667680468||8869126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8007835386||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|
W4|FirstCare|MRSA West|03/01/2012|08/31/2024|STAR|Navitus|610602|MCD|FCH||6082985775||6082985875|providerrelations@navitus.com||8002644111|||||||8779086023||8004317798||https://txstarchip.navitus.com/pages/clinical-edits.aspx||||||
W5|Amerigroup Texas, Inc.|MRSA West|09/01/2014|08/31/2024|STAR+PLUS|CarelonRx|020107|CS|WKEA||8885718182||8003579587|||7132185112|||||||8004543730||8332352022||https://provider.amerigroup.com/texas-provider/home|01/01/2023|||||
W6|Superior Health Plan|MRSA West|09/01/2014|08/31/2024|STAR+PLUS|Express Scripts|003858|MA|2FDA||8667680468||8669126293||https://www.esiprovider.com/|8773915921|||||8337504508||8663990928||8772779772||https://www.superiorhealthplan.com/providers/resources/pharm|01/01/2024||h|h|h|