Pharmacy Manual

The CenCal Health Pharmacy Provider Manual includes information for our Providers regarding the Pharmacy benefit. This manual will assist our providers as a reference guide for the pharmacy benefit such as our prior authorization process, eligibility, other coverage and other important information. If you have any questions about this publication please contact the Pharmacy Services Department at (805) 562-1080.

Click here to view our current CenCal Health Pharmacy Provider Manual or click the links below to access individual sections.

Table of Contents

Section A:  Introduction    

Section B:  Member Eligibility

Section C:  Covered Services

Section D:  Prescription Limitations

Section E:  Formulary Overview

Section F:  Medical Request Forms (MRFs) Process

Section G:  Claims Submission

Section H:  Coordination of Benefits 

Section I:  Provider Grievance System

Section J:  Pharmacy Audits