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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 Informing Materials Request dated 02/01/2021 Melissa Ferrante Document Review 02/03/2021 Ashley Sipes Updated per Informing Materials Request dated 02/03/2021 Melissa Ferrante Document Review DHCS Medi-Cal Rx Provider Manual 3 01/01/2022 Document Version Date Name Comments

Rx Monthly Bulletin found on the Medi-Cal Rx website under Bulletins & News Rhonda Rollins Document Review 1.11 03/01/2022 Ashley Sipes and Samantha Davies For detailed information regarding updates, please see the March 1, 2022, Medi-Cal Rx Monthly Bulletin found on the Medi-Cal Rx website under Bulletins & News Rhonda Rollins 1.12 04/01/2022

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medi-calrx.dhcs.ca.gov

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medi-calrx.dhcs.ca.gov

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medi-calrx.dhcs.ca.gov

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