N.J. Admin. Code § 10:167A-1.3

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:167A-1.3 - Participation of eligible providers

(a) A pharmacy, with a retail or institutional permit, may participate in the PAAD program as a provider of pharmaceutical services.

(b) To be approved as a provider of pharmaceutical services, the pharmacy shall:

1. Operate under a valid retail or institutional permit issued by the Board of Pharmacy of the State of New Jersey and be assigned a national provider identifier. A pharmacy operating under an out-of-State retail or institutional pharmacy permit may not participate as an approved provider in the PAAD program, except for a voluntary prescription drug mail-order program or specialty pharmacy in a Medicare Part D Plan or a mail order prescription drug program required by a PAAD beneficiary's primary payer and, which maintain a permit from the Board of Pharmacy of the State of New Jersey.

2. File an application and sign an agreement with the Department of Human Services (DHS), Division of Medical Assistance and Health Services (DMAHS) and maintain a Medicaid provider number issued by DMAHS.

i. Upon sale or other change of ownership of an approved pharmacy, the agreement is automatically terminated. To execute a new agreement to participate in the PAAD program, the new owner(s) shall apply to the Division, by contacting the Medicaid Provider Enrollment Unit (see N.J.A.C. 10:49, Administration Chapter, Enrollment Process) or the fiscal agent Provider Enrollment Unit.

3. To enroll as a Medicaid provider of pharmaceutical services, a pharmacy shall obtain a copy of the provider application on-line at www.njmmis.com or contact the Fiscal Agent Provider Enrollment Unit (see N.J.A.C. 10:51, Appendix D, Fiscal Agent Billing Supplement).

N.J. Admin. Code § 10:167A-1.3

Amended by R.1997 d.252, effective 6/16/1997.
See: 28 N.J.R. 2481(a), 28 N.J.R. 3221(a), 29 N.J.R. 2678(a).
Amended by R.1998 d.464, effective 9/8/1998.
See: 30 N.J.R. 2197(a), 30 N.J.R. 3309(a).
Recodified from N.J.A.C. 8:83C-1.2 and amended by R.2003 d. 248, effective 6/16/2003.
See: 34 N.J.R. 3456(a), 35 N.J.R. 2642(a).
Amended by R.2009 d.293, effective 10/5/2009.
See: 41 N.J.R. 1637(a), 41 N.J.R. 3804(a).

Amended by 49 N.J.R. 446(a), effective 3/6/2017