Commonwealth of Pennsylvania Web Portal | Provider Enrollment

Enrollment for Pharmacies & Dispensing Prescribers | (includes dispensing physicians & certified registered nurse practitioners)

Please provide the following information:

  1. indicates required field(s)
  2. ** This Provider Federal Tax Identification Number (TIN): Employment Identification Number (EIN): will auto-populate all enrollment tabs and will be used for tax reporting purposes.
    This email address will be used to communicate information about the status of your enrollment.
  4. Enter your Pharmacy Permit Number or State Medical License Number (if enrolling as Physician or CRNP)
    State License number should not include special characters such as “- and .” or spaces.
  1. To update or view an existing application, you must enter the tracking number assigned to your application.
    The tracking number appeared onscreen after you saved or submitted your application, and was also sent to you in an email.

Access Policy

This application and computer system are the property of Magellan Health Services, Inc. and for authorized use only. Users (authorized or unauthorized) have no explicit or implicit expectation of privacy. Users consent via utilization of this application or system to such interception, monitoring, recording, copying, auditing, inspection, and disclosure at the discretion of Magellan Health Services, Inc.

  • Unauthorized use is prohibited;
  • Usage may be subject to security testing and monitoring;
  • Misuse is subject to criminal prosecution;
  • No expectation of privacy except as otherwise provided by applicable privacy laws;
  • Improper use of this application or system may result in disciplinary action, termination of employment and/or civil and criminal penalties, and may be disclosed to law enforcement authorities;
  • Unauthorized attempts to defeat or circumvent security features, to use the system for other than intended purposes, to deny service to authorized users, to access, obtain, alter, damage, or destroy information, or otherwise to interfere with the system of its operation are prohibited;
  • Evidence of such acts may be disclosed to law enforcement authorities and result in criminal prosecution under the Computer Fraud and Abuse Act of 1986 (18 U.S.C 1030) or other applicable criminal laws

For questions or comments, please call the Magellan IT Support Center at (888) 411-6343.