Pharmacy Services for Providers

The state Department of Health Care Services (DHCS) carved out all prescription benefits from Managed Care Plans under a program called Medi-Cal Rx. All pharmacy claims should be submitted directly to the state via its pharmacy benefit manager (PBM), Prime Therapeutics, Inc.

For help with a pharmacy claim or prior authorization, please contact the Medi-Cal Rx Customer Service Center at 1.800.977.2273 or you can send an email or chat here. Agents are available 24 hours a day, seven days a week, 365 days a year.

To submit a prior authorization or an appeal for a pharmacy claim to Medi-Cal Rx, please fax 1.800.869.4325.

If the pharmacy asks for a BIN, PCN, and Group information for billing your pharmacy claims, they will be processed under: BIN 022659, PCN 6334225, Group MEDICALRX.

You may also want to visit the Medi-Cal Rx Communication page for any upcoming bulletins and news.

Medi-Cal Rx Pediatric Integration Implementation Completed as of Friday, April 25, 2025

• As of April 25, 2025, Medi-Cal Rx concluded the implementation of claims UM edits and PA requirements for all members, including members 21 years of age and younger, for all drugs / products including continuation of therapy claims.

• For more information, please refer to the Education & Outreach page on the Medi-Cal Rx Web Portal and selecting the Pediatric Integration tab.

Rite Aid Pharmacy Closures

Rite Aid filed for bankruptcy in October 2023, resulting in the closure of several locations nationwide. On May 5, 2025, Rite Aid filed for bankruptcy again and is in the process of selling assets including prescriptions, to other pharmacies.

In response, the California Department of Consumers Affairs and the California State Board of Pharmacy released a Joint Statement on May 5, 2025. The statement urges prescribers to be responsive to pharmacists' outreach regarding prescription refills and to proactively work with patients to find alternative pharmacies. The closures are expected to significantly affect timely access to prescriptions, particularly in communities where Rite Aid was the primary pharmacy.

For details about when a specific Rite Aid store will be closing, please contact the store directly.

Some Rite Aid locations plan to transfer members’ prescriptions to other pharmacies. To avoid disruption in access to therapy, pharmacy providers and prescribers should encourage members to contact their Rite Aid pharmacy to determine if they need to transfer their prescriptions or if that pharmacy location will transfer their prescriptions for them.

Prescriptions at a Rite Aid location can be transferred to any pharmacy that is contracted with Medi-Cal Rx. To find a participating pharmacy, visit the Medi-Cal Rx website.

For further details and guidance, please refer to the Medi-Cal Rx Rite Aid Closure Guidance for Providers.

DHCS VFC Pharmacy Pilot Program

The Department of Health Care Services (DHCS) is collaborating with the California Department of Public Health (CDPH) on the Vaccines for Children (VFC) Pharmacy Pilot program. DHCS will reimburse Medi-Cal enrolled pharmacy providers who provide immunization services under VFC program to VFC-eligible members in Medi-Cal. My Turn Vaccine Locator is available to find vaccine providers (including pharmacies enrolled in VFC) in a given coverage area: Vaccine Locator – My Turn CA.gov.

The VFC Program helps families by providing vaccines at no cost to medical providers who serve eligible children from birth through 18 years of age. CDC contracts with vaccine manufacturers to buy vaccines at reduced rates. Enrolled providers order federally funded vaccines through their state VFC Program and receive routine vaccines (including influenza) at no cost.

Important Links

• Medi-Cal Rx Website: Please bookmark this website and sign up for the Medi-Cal Rx Subscription Service (MCRxSS) to receive important information directly from DHCS.
• Medi-Cal Rx Provider Portal: Register to get access to beneficiary eligibility lookup, prior authorization, web claims submission, etc.
• Medi-Cal Rx Prior Authorization Requests and Appeals: Gold Coast Health Plan (GCHP) put together this information sheet about how to submit prior authorization requests and appeals to Medi-Cal Rx.
• Medi-Cal Rx Contract Drugs List (CDL): Please bookmark this website for the most up-to-date Contract Drugs List (CDL) from Medi-Cal Rx. It also includes other Covered Products Lists, such as Blood Pressure Monitoring Devices and Continuous Glucose Monitoring Systems.
• Medi-Cal Rx Drug Lookup Tool (DLT): Improved functionality to search by brand or generic drug name or NDC, and identify information about prior authorization requirements or Code I restrictions.

Additional Medi-Cal Rx Resources

• Medi-Cal Rx Bulletins & News
• Medi-Cal Rx Provider Portal
• Medi-Cal Rx Forms & Information
• Medi-Cal Rx Education & Outreach (including updates on Reinstatement)

Medi-Cal Rx News

Pharmacy Newsletters, DUR Educational Articles and FDA Communications