IOWA MEDICAID SUPPLEMENTAL DRUG REBATE AGREEMENTMedicaid Supplemental Drug Rebate Agreement • May 2nd, 2024
Pharmaceutical Manufacturer(“Manufacturer”) Department of the State of Iowa(“Department”) Labeler Code(s): Iowa Department of Health and Human Services Manufacturer Primary Billing Address: Department Primary Billing Address: Iowa Medicaid Drug Rebate PO Box 850195Minneapolis, MN 55485-0195 Manufacturer Primary Contact Person: Department Primary Contact Person: Shari Martin Manufacturer Primary Contact Telephone: Department Primary Contact Telephone: 207-622-7153 EXT 71375 Manufacturer Primary Contact e-mail: Department Primary Contact e-mail: PBA_srcontracts@changehealthcare.com Address for Notices required by Agreement(“Manufacturer Notice Address”): Address for Notices required by Agreement:(“Department Notice Address”): Electronic:Abby Cate, PharmD: acate@dhs.state.ia.us Physical:Iowa Department of Health and Human Services Attn: Abby Cate, PharmD, Pharmacy Consultant 1305 East Walnut StreetDes Moines, IA 50319-0114 Termination Date: (“Termination Date”) Effective Date (
IOWA MEDICAID SUPPLEMENTAL DRUG REBATE AGREEMENTMedicaid Supplemental Drug Rebate Agreement • May 5th, 2020 • Iowa
WYOMING MEDICAID SUPPLEMENTAL DRUG REBATE AGREEMENTMedicaid Supplemental Drug Rebate Agreement • March 2nd, 2023
MISSISSIPPI MEDICAID SUPPLEMENTAL DRUG REBATE AGREEMENTMedicaid Supplemental Drug Rebate Agreement • January 26th, 2022
Agreement and for other good and valuable consideration, the receipt, adequacy and legal sufficiency of which are hereby acknowledged, the parties have entered into this Agreement and have caused their duly authorized representatives to execute this Agreement below.
WYOMING MEDICAID SUPPLEMENTAL DRUG REBATE AGREEMENTMedicaid Supplemental Drug Rebate Agreement • May 5th, 2020 • Wyoming
MISSISSIPPI MEDICAID SUPPLEMENTAL DRUG REBATE AGREEMENTMedicaid Supplemental Drug Rebate Agreement • May 5th, 2020 • 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
NORTH DAKOTA MEDICAID SUPPLEMENTAL DRUG REBATE AGREEMENTMedicaid Supplemental Drug Rebate Agreement • March 4th, 2019 • North Dakota
NORTH DAKOTA MEDICAID SUPPLEMENTAL DRUG REBATE AGREEMENTMedicaid Supplemental Drug Rebate Agreement • April 4th, 2024
SOUTH DAKOTA MEDICAID SUPPLEMENTAL DRUG REBATE AGREEMENTMedicaid Supplemental Drug Rebate Agreement • April 2nd, 2024
IOWA MEDICAID SUPPLEMENTAL DRUG REBATE AGREEMENTMedicaid Supplemental Drug Rebate Agreement • October 1st, 2008 • Iowa
This Agreement is made and entered into this day of (YEAR), by and between the State of Iowa (State), represented by the Department of Human Services (Department), and (Manufacturer), Labeler Code
