Pharmacist Provider Enrollment

Pharmacists electing to provide services covered by Medicaid should complete the following steps to request enrollment with UnitedHealthcare Community Plan.


  • In compliance with federal requirements in the 21st Century Cures Act, most states require all providers to first enroll with their state Medicaid program, as applicable.
  • If you are not currently enrolled with the state Medicaid program, visit the following link for more information: State Medicaid Enrollment Resources
  • Once enrolled with Medicaid, please complete and submit this form to initiate the process with UnitedHealthcare
  • This form may be used for up to 3 pharmacists per pharmacy location; however, there is no limit to the number of pharmacists per location. To request enrollment for additional pharmacists, please complete additional form submissions as needed.
  • Within 3-5 business days, you should receive a secure email from UnitedHealthcare requesting any additional documents required for enrollment.
  • When all the required documentation is submitted and reviewed for completion, UnitedHealthcare will send a provider contract via DocuSign for electronic signature.
  • Once your contract has been completed, and you are enrolled as a provider, visit Get Connected on our UHC.provider.com website to learn how to create a One Healthcare ID and a UnitedHealthcare Provider Portal Profile.


For questions or concerns related to Community Plan Pharmacist Provider Enrollment email us at: uhccs_pharmacy@uhc.com

Name of primary contact for this enrollment request

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Tax ID of payable entity

Select all applicable:

(Note: Pharmacists must enroll with the respective State Medicaid Program prior to enrolling with UnitedHealthcare.)


**For questions related to OptumRx contracting or to request a contract, please contact us at: Independent Contracting 11000 Optum Circle, Eden Prairie, MN 55344

Fax: 1-844-305-2623 Email: independent.contracting@optum.com **

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Please indicate the plans with which you wish to enroll:

Pharmacists requesting enrollment in Delaware may contract with our Commercial Employer & Individual Plans.

Please indicate that you wish to enroll with UHC Delaware Commercial plans:

Last name, First name MI

Please provider license information for the state in which you are requesting enrollment.

Are there additional pharmacists enrolling at this location?

Last name, First name, MI

if applicable

Please provider license information for the state in which you are requesting enrollment.

Are there additional pharmacists enrolling at this location?

Last name, First name MI

if applicable

Please provider license information for the state in which you are requesting enrollment.

UnitedHealthcare Community Plan is not currently accepting electronic enrollment requests for your state. We actively monitor regulatory changes associated with provider enrollment across all Medicaid markets. Your request will remain on file for a period of 1 year. We will reach out to you if we begin enrolling pharmacists in your state.

Please provide a copies of the following:

  • Pharmacy W-9
  • Proof of professional liability insurance
  • CLIA waiver documentation, if applicable
  • Proof of training program completion, if applicable
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