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Medi-Cal Rx Provider Manual

Proprietary & Confidential 2022 California Department of Health Care Services. All rights reserved. Medi-Cal Rx Provider Manual Version January 1, 2022 DHCS Medi-Cal Rx Provider Manual 2 01/01/2022 Revision History Document Version Date Name Comments 10/05/2020 Ashley Sipes Initial Creation Bridgette Devine/ Melissa Ferrante Document Review 11/05/2020 Ashley Sipes Updated according to DHCS feedback Melissa Ferrante Document Review 11/30/2020 Ashley Sipes Updated according to DHCS feedback Melissa Ferrante Document Review 12/16/2020 Ashley Sipes Updated according to DHCS feedback Melissa Ferrante Document Review 12/29/2020 Ashley Sipes Updated according to DHCS feedback Melissa Ferrante Document Review 12/31/2020 Melissa Ferrante Finalized document following DHCS approval 02/01/2021 Ashley Sipes Updated per

DHCS – Medi-Cal Rx Provider Manual 3 01/01/2022 Document Version Date Name Comments 1.3 02/12/2021 Ashley Sipes Updated per Urgent Informing

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