Section 5: Pharmacy

Table of Contents - Medi-Cal

Policy/Procedure Title	Policy Number
Pharmacy & Therapeutics Committee	MPRP4001
Conflict of Interest Agreement	MPPR4001-A
340B Compliance Program Archived October 2022 Due to Carve Out	MCRP4060
AB1114 Benefits Implementation and Oversight	MCRP4066
Continuation of Prescription Drugs	MCRP4064
Drug Wastage Payments	MPRP4062
Allowable Waste Drug List	MPRP4062-A
Medical Benefit Medication TAR Policy	MCRP4068
Medi-Cal Treatment Authorization Request Form	MCRP4068-A
PHC Treatment Authorization Request Form (Medical Drug Benefit - PAD Form)	MCRP4068-B
Pharmaceutical Patient Safety	MPRP4034
Prescriber Letter	MPRP4034-A
Sample Member Letter	MPRP4034-B

Please Direct Questions To:

Partnership HealthPlan of California
4665 Business Center Drive
Fairfield, CA 94534
Phone: (707) 863-4100