Medicaid Provider Information
Pharmacy Provider Forms
- Drug/Pharmacy Claim Form (SFN 00634)
- Pharmacy Adjustment Form (SFN 00640)
- Prior Authorization for Medical Equipment or supplies Form (SFN 01115)
- Pharmacy Prior Authorization Information and Forms - Health Information Designs (HID) is North Dakota Medicaid's Prior Authorization Vendor.
If you have pharmacy questions, you may e-mail them to dhsmed@nd.gov. If you have pharmacy billing questions, please contact provider relations at (701) 328-4030.
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