Contacts
- LACDMH Pharmacy Services Contacts List (last updated 9/2023)
Pharmacy List
- LACDMH Network Pharmacies List (last updated 8/2023)
Medication Formulary
- LACDMH Formulary (last updated 1/2023)
- LACDMH Prior Authorization (PA) Request Form (last updated 10/2019) for Non-Formulary and Restricted Formulary Medications
Medication Access Programs
- Prescription Drug Coverage through LACDMH-Magellan
Eligibility Criteria:- Client is uninsured (i.e. has no active Medi-Cal, Medicare Part D, or other third-party prescription drug coverage)AND
- Client has at least 1 open episode in AVATAR AND
- If the most recent episode was opened > 3 months ago, client has received documented LACDMH service(s) within the last 3 months
If a client meets above criteria, either client, prescriber, prescriber’s staff, or retail pharmacy staff, may contact LACDMH-Magellan’s Customer Call Center at 800-424-6811 to obtain or renew a Magellan ID number for client. Network retail pharmacies will need the following information to process prescription drug claims for client.
-
- Magellan ID# __________
- RxBIN: 016523
- RxPCN: 52268989
- RxGRP: LACOUNTY
- Medicare Copay Assistance
PHI Fax Cover Sheet
- LACDMH PHI Fax Cover Sheet (last updated 7/2016)
Ordering Clinic Stock Medications and Supplies from LACDMH Pharmacy Warehouse (for LACDMH Staff Only)
Where to Dispose of Unused Medications
Prescription Pad Request (for LACDMH Staff Only)
Page last updated: 09/20/2023