Provider Enrollment

New York State Medicaid enrolls pharmacies under one of seven provider types: clinic, hospital, community, long-term care, mail order, home infusion therapy, and compounding pharmacies. The seven types of pharmacies and the applicable Categories of Service (COS) are listed below. To avoid application processing delays, please refer to the pharmacy manual for a definition of each COS to choose the correct COS enrollment type.

Option 1

Clinic Pharmacy (COS 0161)

Hospital Pharmacy (COS 0288)

Click here for the Enrollment Form and Instructions.

Option 2

Pharmacy (COS 0441)

Click here for the Enrollment Form and Instructions.

Option 3

Mail Order Pharmacy (COS 0450)

Home Infusion Therapy Pharmacy (COS 0451)

Compounding Pharmacy (COS 0452)

Long Term Care (LTC) Pharmacy (COS 0453)

Specialty Pharmacy (COS 0445)

Click here for the Enrollment Form and Instructions.

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