Searchable state-by-state Medicaid 340B requirements
This resource has been created by the 340B Prime Vendor Program to assist stakeholders by combining the most recently available 340B-specific Medicaid data with publicly available federal data. Please note that additional requirements or contractual obligations that may be in place from third-party payers are not included in this resource.
Upon selecting a state in the drop-down menu, the Medicaid State Technical, Rebate and Policy contacts and details on the state’s retail prescriptions, provider- or facility-administered drugs, contract pharmacies and Medicaid Managed Care profiles will populate below. Each field is linked to the sourced data where additional information can be found.
Please note: The data presented on this page are compiled from various sources; however, the information is not endorsed by HRSA and not dispositive with the 340B Drug Pricing Program. 340B stakeholders are ultimately responsible for 340B Program compliance and compliance with all applicable state and federal laws and regulations. Stakeholders are encouraged to contact the states to verify current policy/requirements.
Technical contact
PRIME THERAPEUTICS STATE GOVERNMENT SOLU
martin vincent
MARTIN.SAMMANASUVINCENT@PRIMETHERAPEUTICS.COM
2900 ames crossing rd suite 200
eagan, MN 55121
(612) 318-5702
Rebate contact
PRIME THERAPEUTICS STATE GOVERNMENT SOLU
courtney towse
COURTNEY.TOWSE@PRIMETHERAPEUTICS.COM
15 cornell road suite 2201
latham, NY 12110
(612) 318-5492
Policy contact
NYS DOH
bonny decastro
99 washington avenue, 1 commerce plaza
albany, NY 12210
(518) 948-5089
New York Medicaid State Details as of 26-JAN-26
Fee-For-Service (FFS) Information
Pharmacy Benefit Manager (PBM), BIN, PCN, and Group ID Information
FFS Pharmacy Benefit Manager
Retail Pharmacy Transactions
Drug Cost (submissions)
Drug cost type when 340B drugs are dispensed.
Drug Cost (reimbursements)
Drug cost type state plans reimburse at for 340B dispenses.
Required Claim Identifiers
Claim identifiers required to indicate 340B drugs were dispensed.
Professional Dispensing Fee (PDF)
The current professional dispensing fee for FFS 340B claims. Note: some states have ranges based on different factors.
Provider or Facility Administered Transactions
Drug Cost (submissions)
Drug cost type when 340B drugs are administered.
Drug Cost (reimbursements)
Drug cost type state plans reimburse at for 340B dispenses.
Required Claim Identifiers
Claim identifiers required to indicate 340B drugs were administered.
Contract Pharmacies*
State Permits 340B via Contract Pharmacy
* Despite Federal position on dispensing through CP arrangements
Medicaid Managed Care Organization (MCO) Information
Plans/Vendors, Pharmacy Benefit Managers (PBM), BIN, PCN, and Group ID Information
State uses MCO plans?
Does the state use MCO(s) to manage Medicaid services?
Retail Pharmacy Transactions
Drug Cost (submissions)
Drug cost type when 340B drugs are dispensed.
Drug Cost (reimbursements)
Drug cost type state plans reimburse at for 340B dispenses.
Required Claim Identifiers
Claim identifiers required to indicate 340B drugs were dispensed.
Professional Dispensing Fee (PDF)
The current professional dispensing fee for FFS 340B claims. Note: some states have ranges based on different factors.
Provider or Facility Administered Transactions
Drug Cost (submissions)
Drug cost type when 340B drugs are dispensed.
Drug Cost (reimbursements)
Drug cost type state plans reimburse at for 340B dispenses.
Required Claim Identifiers
Claim identifiers required to indicate 340B drugs were dispensed.
Contract Pharmacies
State Permits 340B via Contract Pharmacy
Billing as a Medicaid Secondary Claim (Medicare, Commercial), use “20” in the Submission Clarification Code field (NCPDP field #420-DK) and the plan should be consulted for their requirements in the 423-DN, Basis of Cost Determination (BCD) field.