Common Contracts

MISSISSIPPI MEDICAID SUPPLEMENTAL DRUG REBATE AGREEMENT

Supplemental Drug Rebate Agreement • May 5th, 2020 • Mississippi

• Contract Type
  Supplemental Drug Rebate Agreement
• Filed
  May 5th, 2020
• Jurisdiction
  Mississippi

Pharmaceutical Manufacturer (“Manufacturer”): State of Mississippi Division of Medicaid (“DOM”): «Company_Name»Labeler Codes: «Labeler_Code_1»,«Labeler_Code_2», «Labeler_Code_3» State of Mississippi Division of Medicaid Manufacturer Primary Billing Address: DOM Primary Billing Address: «Company_Name»«Address_1»«Address_2»«Address_3»«City», «State» «Zip_Code» GHS, Inc. – Mississippi RebateP.O. Box 1038Augusta, ME 04332-1038 Manufacturer Primary Contact Person: DOM Primary Contact Person: «Manufacturer_Primary_Contact» Rossi Rowe Manufacturer Primary Contact Telephone: DOM Primary Contact Telephone: «Office_Phone» 877-399-8556 Manufacturer Primary Contact e-mail: DOM Primary Contact e-mail: «Email_Address» rxoffers@rxssdc.org Address for Notices required by Agreement (“Manufacturer Notice Address”): Address for Notices required by Agreement: (“DOM Notice Address”): «Manufacturer_Notice_Contact»«Address_1»«Address_2»«Address_3»«City», «State» «Zip_Code» Mississippi Division of MedicaidD