Procedure Reimbursement Rate Request
Contracted providers can use this form to request reimbursement rate information from the Alliance. Please read the instructions tab in its entirety prior to filling out and submitting the form. Providers that are non-contracted with the Alliance may not utilize this form, but may obtain Medi-Cal rates on the Department of Healthcare Services DHCS website.
Click image below to open Excel file:
Contact Pharmacy Department
Phone: 831-430-5507
Fax: 831-430-5851
Monday-Friday, 8 a.m. to 5 p.m.