Network Enrollment Request Instructions

Thank you for your interest in joining PDMI’s pharmacy network. Any pharmacy provider that completes the enrollment application, provides all the necessary documentation, and passes our credentialing and minimum conditions for participation standards is welcome to participate. 

  1. Complete credentialing application in its entirety
    1. Enrollment Instructions
    2. Credentialing Application
  2. Provide all required documentation
    1. FWA Attestation
    2. State Pharmacy License
    3. Pharmacist-in-Charge State License
    4. DEA Certificate
    5. Professional Liability Insurance Certificate
    6. Federal Tax ID Certificate
    7. W9
    8. Medicare ID Award
  3. Return the application and required supporting documentation to:
    1. Email:
    2. Fax: 330-757-8487
    3. Mail: PDMI Pharmacy Enrollment, 8530 Crossroads Dr., Poland OH 44514
  4. PDMI will review the enrollment application and provide notice to the pharmacy provider when:
    1. Additional information is required to complete enrollment.
    2. The application for enrollment is denied for any reason.
    3. The application for enrollment is accepted.
  5. Once the application is accepted, a pharmacy services agreement (PSA) will be provided to you for your review and signature.
    1. Please sign the pharmacy services agreement provided and return to PDMI.
    2. Only after receiving a signed full copy of the PSA will the applicant then be implemented into the PDMI network per the supporting PSA.
    3. The applicant will receive a welcome letter notifying them of the effective date of participation and a countersigned copy of the PSA.

Please allow up to 10 business days for processing of the submitted application. To check on your status after 10 business days, please email your request to and include your NCPDP # in the subject line of the email along with your request.

Please note that PDMI utilizes monthly NCPDP DataQ update information to maintain the majority of pharmacy provider demographic information for the PDMI pharmacy directories and networks. Please update your NCPDP profile information in a timely manner to ensure the PDMI directories are also updated with the desired effective dates. PDMI will no longer be taking or responding to requests pertaining to updates to most pharmacy demographic information, such as phone numbers and addresses as these will be maintained via the DataQ update process.