Maine.gov
Provider Help Desk: (p) 888-420-9711 (f) 800-408-1088 | Member Help Desk: (p) 866-796-2463 (f) 207-287-8601
Prior Authorization (PA) Helpdesk (for Provider PA inquiries): (p) 888-445-0497 (f) 888-879-6938

General Pharmacy Info

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Name Description Date
Pharmacy List by NPI 341.03 KB 2015/02/02
Pharmacy List by Name 341.17 KB 2015/02/02
Morphine Sulfate Equivalent (MSE) Chart 149.05 KB 2013/02/04
MaineCare PDL Splitting Tables 69.12 KB 2011/07/22
MaineCare PDL Dose Consolidation List 69.48 KB 2011/07/22

CMS Rebatable List

Name Description Date
CMS Rebatable Drug List 2Q2014 1.52 MB 2014/08/18
CMS Rebatable Drug List 4Q2013 11.04 MB 2014/02/18
CMS Rebatable Drug List 1Q2013 673.85 KB 2014/01/23
CMS Rebatable Drug List 3Q2013 716.18 KB 2013/11/18
CMS Rebatable Drug List 2Q2013 725.69 KB 2013/08/23

Memos and Mailings

Forms

Name Description Date
Reversal Form 24.76 KB 2014/08/28
MEPOP Manual Claim Form NCPDP D.0 84.91 KB 2014/04/29
ME Compound Manual Claim form NCPDP D.0 80.83 KB 2014/04/29
MEPARTD Manual Claim Form NCPDP D.0 86.11 KB 2014/04/29
BMS012 Form 64.22 KB 2010/12/23

Maine Rx Plus

Name Description Date
MaineRx Plus Pharmacy List by NAME 135.91 KB 2010/03/05
MaineRx Plus Pharmacy List by NABP 135.84 KB 2010/03/05
MaineRx Plus Pharmacy List by NPI 135.84 KB 2010/03/05