MRS Title 22, §3174-R. MEDICAID DRUG REBATE PROGRAMMedicaid Drug Rebate Agreement • March 20th, 2018
MRS Title 22, §3174-R. MEDICAID DRUG REBATE PROGRAMMedicaid Drug Rebate Agreement • March 20th, 2018
NOTE TO: All State Medicaid DirectorsMedicaid Drug Rebate Agreement • December 29th, 2011
We received a rebate agreement from Falcon Ophthalmics, Incorporated (Labeler Code 61314) which is a new company owned by Alcon Laboratories, Incorporated. Since their parent company is already a participating labeler, Falcon Ophthalmics, Incorporated will be joining the rebate program retroactive to January 1, 1995.
MEDICAID DRUG REBATE AGREEMENT CONTACT INFORMATION SHEETMedicaid Drug Rebate Agreement • November 4th, 2020
Note: This sheet is to be returned with the signed rebate agreement. If more than one labeler code, attach one sheet for each code.
ContractMedicaid Drug Rebate Agreement • March 30th, 2016
MEDICAID DRUG REBATE AGREEMENTENCLOSURE B (PAGE 1 OF 2) SUPPLEMENTAL DATA SHEET LABELER CODE (as assigned by FDA) LABELER NAME (Corporate name associated with labeler code) LEGAL CONTACT – Person to contact for legal issues concerning the rebate agreement NAME OF CONTACT AREA PHONE NUMBER EXTENSION EMAIL ADDRESS: NAME OF CORPORATION STREET ADDRESS CITY STATE ZIP CODE INVOICE CONTACT – Person responsible for processing invoice utilization data NAME OF CONTACT AREA PHONE NUMBER EXTENSION EMAIL ADDRESS: NAME OF CORPORATION STREET ADDRESS CITY STATE ZIP CODE
National Drug Rebate Agreement (NDRA)Medicaid Drug Rebate Agreement • August 31st, 2020
All MDP users will be required to have their own Enterprise Identity Management (EIDM) account. Once access has been granted, you must sign in and request an NDRA.
MRS Title 22, §3174-R. MEDICAID DRUG REBATE PROGRAMMedicaid Drug Rebate Agreement • March 20th, 2018
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.
MEDICAID DRUG REBATE AGREEMENT CONTACT INFORMATION SHEETMedicaid Drug Rebate Agreement • February 19th, 2020
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 CONTACT INFORMATION SHEETMedicaid Drug Rebate Agreement • June 21st, 2021
Note: This sheet is to be returned with the signed rebate agreement. If more than one labeler code, attach one sheet for each code.
