Get New York Medicaid Smac Price Research Request Form - Emedny - Emedny

Filling out the New York Medicaid SMAC Price Research Request Form accurately is essential for ensuring a prompt response from the Medicaid Pharmacy Policy & Operations staff. This guide will provide you with step-by-step instructions to navigate the online form efficiently.

Follow the steps to complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date in the specified field at the top of the form.
3. In the Provider Information section, fill out the following required fields: Provider Name, Phone Number, Contact Name, Fax Number, and NPI Number, ensuring that all information is accurate.
4. Next, move to the Drug Information section. Provide the required fields: Drug Name, NDC Number, Provider Acquisition Cost, Drug Strength, and DAW Code.
5. Additionally, complete the fields for Drug Dosage Form, RX Number, and Quantity Dispensed.
6. If applicable, provide the Recipient ID Number in the designated area.
7. Include any relevant comments about product availability or price modification in the Comments section below the drug information.
8. Once all required fields are filled, review your entries for accuracy. Ensure there are no illegible or incomplete sections that could delay processing.
9. Finally, save your changes. You can then download, print, or share the completed form as required.

Complete your documents online today to ensure a timely and effective response.