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State of California Health and Human Services Agency Department of Managed Health Care APPLICATION FORM FOR PHARMACY BENEFIT MANAGER REGISTRATION DMC 10242 New: 08/19 Rev: 08/19 OFFICIAL USE ONLY FEE

How to fill out dmhc 10-242 pbm registration

How to fill out dmhc 10-242 pbm registration

1. Start by downloading the DMHC 10-242 PBM Registration form from the official DMHC website.
2. Fill out the top section of the form, which includes your name, address, phone number, and other contact information.
3. Provide your PBM organization details, such as the name, address, and contact information.
4. Indicate the type of PBM services you provide, such as prescription drug claims processing or pharmacy network services.
5. Specify the type of business entity you are, whether a corporation, partnership, or sole proprietorship.
6. Complete the ownership and control section, providing details about the ownership structure of your PBM organization.
7. Fill out the disclosure section, providing information about any criminal convictions or disciplinary action against your PBM organization.
8. Sign and date the form, certifying that the information provided is true and accurate.
9. Prepare any additional supporting documents, such as financial statements or ownership control charts.
10. Submit the completed DMHC 10-242 PBM Registration form and supporting documents to the appropriate DMHC office.

Who needs dmhc 10-242 pbm registration?

1. Any Pharmacy Benefit Manager (PBM) organization operating in California needs DMHC 10-242 PBM Registration. This includes entities that provide PBM services such as prescription drug claims processing, pharmacy network services, or any other services related to pharmacy benefits management.

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What is dmhc 10-242 pbm registration?

dmhc 10-242 PBM registration is the process by which pharmacy benefit managers (PBMs) register with the Department of Managed Health Care (DMHC) in California.

Who is required to file dmhc 10-242 pbm registration?

PBMs operating in California are required to file dmhc 10-242 PBM registration.

How to fill out dmhc 10-242 pbm registration?

To fill out dmhc 10-242 PBM registration, PBMs need to provide detailed information about their operations, services, financials, and compliance with state laws.

What is the purpose of dmhc 10-242 pbm registration?

The purpose of dmhc 10-242 PBM registration is to ensure transparency, oversight, and compliance with California's healthcare laws for PBMs.

What information must be reported on dmhc 10-242 pbm registration?

PBMs must report information such as business operations, services provided, financials, and compliance with state laws on dmhc 10-242 PBM registration.