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Provider Enrollment > Pharmacy

Provider Enrollment



New York State Medicaid enrolls pharmacies under one of three pharmacy provider types – clinic pharmacies, hospital pharmacies, and community pharmacies. Listed below are the three types of pharmacies, the applicable Categories of Service (COS), and a brief description of the characteristics of each. To avoid application processing delays, please review the criteria and choose the correct COS.

Option 1

Hospital Pharmacy (COS 0288)

  • Owned and operated by an Article 28 facility or other entities;
  • Services patients in the hospital and may also provide outpatient services;
  • Physically adjacent to or embedded within the hospital it serves;

Clinic Pharmacy (COS 0161)

  • Owned and operated by an Article 28 facility or other entities;
  • Services only the patients of the clinic;
  • Physically adjacent to or embedded within the clinic it serves;

Click here for the Enrollment Form and Instructions.


Option 2

Pharmacy (COS 0441)

  • Outpatient dispensing, community-based pharmacies that include:
    • Independently owned;
    • Chain; and
    • Those owned by a non-profit entity whose physical space is separate and distinct from the physical space of other healthcare services provided by the non-profit entity (e.g., does not share a waiting room with another office or clinic, patients do not need to walk through an office area to present to pharmacy); and/or
  • Pharmacies that are contracted with and provide drugs to Medicaid members residing in Medicaid enrolled facilities; and/or
  • Pharmacies that provide drugs to Medicaid members at the site where they are being administered or infused by a practitioner.

Click here for the Enrollment Form and Instructions.


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