Common Contracts
1 similar Medicaid Drug Rebate Agreement contracts
MEDICAID DRUG REBATE AGREEMENT CONTACT INFORMATION SHEET Note: This sheet is to be returned with the signed rebate agreement. If more than one labeler code, attach one sheet for each code.Medicaid Drug Rebate Agreement • December 12th, 2019
Form CMS-367d (Exp.) is used by manufacturers when they have a need to update CMS on contact information such as email address, phone number, or address, of their legal, invoice or technical contact for the Medicaid Drug Rebate Program. When needed, the use of Form CMS-367d by manufacturers is considered mandatory under the authority of Section 1927 of the Social Security Act and the National Drug Rebate Agreement. Under the Privacy Act of 1974 any personally identifying information obtained will be kept private to the extent of the law.
