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Medicaid Provider Enrollment



On February 20, 2020, Iowa Department of Human Services (DHS) released Informational Letter No. 2105-MC-FFS (replacing IL No. 2048 dated 11/18/2019) detailing the process for pharmacists to enroll as providers. Iowa Medicaid has added a new provider type for pharmacists, allowing pharmacists to enroll as a Medicaid provider immediately. As stated in the letter, enrollment will permit a pharmacist, pursuant to statewide protocols, to order and dispense naloxone and nicotine replacement therapy products, as well as to order and administer vaccines to Medicaid members.

Click the image below to review IPA’s Iowa Medicaid Provider Enrollment 101 resource.


Enrollment is through a paper application only. There is no fee to enroll as a Medicaid provider with the IME.  

To enroll under this new provider type, a pharmacist must:
1. Complete the Iowa Medicaid Universal Provider Enrollment Application Form 470-0254 (Section B)
     a. In box 16, enter type code 82.
     b. In boxes 31 a-c, enter the pharmacy NPI, Taxonomy Code, and Location Zip Code. If employed at more than one location (pharmacy), you will have to submit a completed application for each location. 

  • Include a copy of your Iowa Board of Pharmacy Pharmacist License. Obtain through the Board of Pharmacy’s new online portal. 
  • Include a copy of the certificate from a college of pharmacy or an ACPE-accredited CE program on vaccine administration (if applicable). 
  • Include a copy of current basic cardiac life support or CPR training certificate.
  • Include a copy of all applicable ACPE-approved CE certificates relative to vaccines, naloxone, and nicotine replacement therapy.  
2. To be recognized by AmeriGroup and Iowa Total Care, complete Iowa Medicaid Universal Provider Enrollment Application Form 470-0254 (Section C). In lieu of completing Section C, you can complete the credentialing process with the Council for Affordable Quality Healthcare (CAQH), a nationally recognized online credentialing service.
     a. Please note that Iowa Total Care will require you to set up a contract if you don't already have a DME contract. To do so, complete the Request to Contract Form on their website. Once completed, a Contract Manager will reach out to you to begin the credentialing and contracting process.
   b. To begin the provider credentialing process with Amerigroup, email to request credentialing information.

Click here to review Iowa Medicaid's Provider Enrollment process flow chart.

Additional Forms:

Pharmacist Affiliation 
Can a pharmacist enroll if not affiliated with a pharmacy? 

To be eligible, a pharmacist must be providing services at a pharmacy enrolled with Iowa Medicaid. (Updated Dec. 2021)

If a pharmacist enrolls under their individual Social Security Number, they will be required to submit additional enrollment forms including: 

How does a pharmacist affiliated with a medical office enroll? The pharmacist would enroll and link themselves to the physician group. 
Managed Care 
Will the MCOs have an additional provider enrollment process? 

Only AmeriGroup has an additional enrollment/credentialing process. This can be completed by completing Section C of the application or complete the credentialing process with the Council for Affordable Quality Healthcare (CAQH), a nationally-recognized online credentialing service. 

Additional questions related to MCO enrollment should be directed to the appropriate MCO.

  • The Iowa Total Care pharmacist enrollment contact varies depending on where the pharmacist is geographically located. There is a map with contact information located on Iowa Total Care's website.
  • Amerigroup pharmacist enrollment questions can be directed to
  • Molina Health Care of Iowa pharmacist enrollment contact varies depending on where the pharmacist is geographically located. There is a map with contact information located on Molina's website.
Does IME provide guidance to the MCOs on their enrollment process?  No. Each MCO has their own credentialing requirements. Review the webpages below.
Continuing Education (CE) and Additional Documentation
Will pharmacists need to submit new education verification with each renewal period?  Yes.
How far back do you need CE? 

Provide the CE indicated in 29 a-c. 

  • For a. that means the initial qualification (course) as noted under “i”. Then current certificates under “ii-iii” as required under the Board of Pharmacy’s rules within the license renewal period.
  • For b. and c. that means the certificate for the CE in each area obtained during the current or past licensing period as required under the Board of Pharmacy’s rules. 
How do I obtain a copy of my immunization certificate?
If completed through CEimpact, submit a request here. If completed through APhA, email
Does IME work with credential verification services for providers?  No.
Is there an online application? No, there is not an online application. Enrollment is through a paper application only. 
Is there a fee to enroll as a Medicaid provider?  No.
Is it possible for an employer (e.g., office manager) to submit on behalf of employee pharmacists (e.g., clinics, hospitals, chains)? If so, what will the process be for this?  Yes. The process is the same. 
How can I verify if my application has been approved?
Iowa Medicaid and the MCOs do not offer a searchable database to verify your application status. If it has been more than 10 days since you have submitted your application and you have not received any notification, please reach out via email to the appropriate provider enrollment services help desk.
Iowa Medicaid Enterprise Provider Services
Iowa Total Care