PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
the document
for the current year.
Pharmacy Enrollment Form - New York
Pharmacy Enrollment Form is a legal document that was released by the New York State Department of Health - a government authority operating within New York.
FAQ
Q: What is the Pharmacy Enrollment Form?
A: The Pharmacy Enrollment Form is a form used for pharmacies in New York to enroll in various programs.
Q: Who needs to fill out the Pharmacy Enrollment Form?
A: Pharmacies in New York that want to participate in state programs need to fill out the Pharmacy Enrollment Form.
Q: What programs can pharmacies enroll in with the Pharmacy Enrollment Form?
A: Pharmacies in New York can enroll in programs such as Medicaid, Child Health Plus, and AIDS Drug Assistance Program (ADAP) using the Pharmacy Enrollment Form.
Q: Are there any fees to submit the Pharmacy Enrollment Form?
A: No, there are no fees to submit the Pharmacy Enrollment Form.
Form Details:
- Released on April 1, 2017;
- The latest edition currently provided by the New York State Department of Health;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New York State Department of Health.
