Prescription Drug Formulary
Member Pharmacy Refund Form
Please read carefully before completing this form. Claim forms without the required information cannot be processed and will be returned to sender.
WVCH Current Drug Lists:
|July 1, 2017||Medicaid MedImpact Formulary||New formulary for WVCH members – Effective 03/28/2018||Download|
|January 01, 2016||Medicaid WRAP/D-Excluded Formulary||New formulary for members who have Medicare as their primary insurance and WVCH as their secondary (dual eligible members) – Effective 01/01/2016||Download|
WVCH Drug List Changes: