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​Information for 340B Covered Entities

The following Medical Assistance (MA) Bulletin applies to 340B covered entities that bill the MA Fee-for-Service (FFS) program and/or a MA Program managed care organization (MCO) for drugs purchased under the 340B Drug Pricing Program and dispensed to MA program beneficiaries:

The following MA Bulletins apply to 340B covered entities that bill the MA FFS program for 340B purchased drugs:

 

2022 Pennsylvania Medical Assistance BIN/PCN/Group Numbers

FFS/MCO

BIN

PCN

Group Number

Fee-For-Service

600760

N/A

N/A

Aetna Better Health

610591

ADV

Rx8813

AmeriHealth Caritas Pennsylvania

019595

01940000

N/A

AmeriHealth Community Health Choices

019595

07630000

N/A

Gateway Health Plan (Medicaid Primary) (End Date 12/31/2021)

004336

ADV

RX2338

Gateway Health Plan (Medicaid Primary) (Effective 1/1/2022)004336MCAIDADVRX2338

Gateway Health Plan (Medicaid Secondary to Medicare)

012114

COBSEGADV

RX2338

Gateway Health Plan (Medicaid Secondary to Commercial Insurance)

013089

COMSEGADV

RX2338

Geisinger Health Plan

019595

PRX11804

N/A

Health Partners of Philadelphia

004336

MCAIDADV

RX3892

Keystone First Community Health Choices

019595

07630000

N/A

Keystone First

019595

01940000

N/A

Pennsylvania Health & Wellness (End Date 1/31/2022)

020545

RXA373

RXGMCPA01

Pennsylvania Health & Wellness (Effective 2/1/2022)

004336

MCAIDADV

RX5455

United Healthcare Community Plan

610494

4200

ACUPA

UPMC for You

003858

A4

PMDM

Last updated December 20, 2021