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Managed Care Pharmacy Participation

Pharmacy providers must enroll in Medicaid through the Provider Enrollment and Management System (PEMS) before participating in any managed care network. Refer to the Enrollment Process section for information about the enrollment process

Each MCO contracts with a pharmacy benefits manager (PBM) to process prescription claims. The PBM contracts with individual pharmacies. The MCO must allow any enrolled pharmacy provider willing to accept the financial terms and conditions of the contract to enroll in the MCO’s network. Each MCO develops its participating pharmacy network for the delivery of services.