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This document certifies that a contract exists between a hospital and state/local government to provide healthcare services to low-income individuals, complying with Section 340B of the Public Health

How to fill out certification of contract with

How to fill out Certification of Contract with State/Local Government to Provide Health Care Services

1. Obtain the Certification of Contract form from the relevant state/local government website or office.
2. Read the instructions carefully to understand the requirements.
3. Complete the identifying information section with your organization's details.
4. Provide a detailed description of the health care services you will be offering.
5. Attach any necessary documentation that supports your application, such as proof of qualifications or licenses.
6. Include any financial disclosures that may be required.
7. Review the form for accuracy and completeness.
8. Sign and date the form as required.
9. Submit the completed form along with any attachments to the appropriate state/local government agency.

Who needs Certification of Contract with State/Local Government to Provide Health Care Services?

1. Health care service providers seeking to contract with state or local government agencies.
2. Organizations delivering public health services that require government funding or approval.
3. Businesses aiming to comply with regulatory requirements for health care services.

People Also Ask about

Is DSH the same as 340B?

There are six hospital types eligible to participate in the 340B Program: Disproportionate Share Hospitals (DSH) Sole Community Hospitals (SCH) Rural Referral Centers (RRC)

What is 340B A )( 4 of the Public Health Service Act?

Section 340B(a)(4) of the Public Health Service Act (PHS) Act (42 U.S.C. 256b) lists eligible organizations that can participate in and purchase discounted drugs under the 340B Program. HRSA's Office of Pharmacy Affairs (OPA) requires registration and approval for covered entities to participate in the 340B Program.

What is the simple explanation of 340B?

Section 340B of the Public Health Service Act requires pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at discounted prices to health care organizations that care for many uninsured and low-income patients.

Who are the participants in the 340B program?

Section 340B requires pharmaceutical manufacturers that participate in the Medicaid and Medicare Part B programs to enter into a contract with the Secretary of Health and Human Services (HHS) requiring them, among other things, to give specified discounts on covered outpatient drugs purchased by certain “covered

What are the restrictions of the 340B program?

The 340B law prohibits the resale or transfer of discounted outpatient drugs to anyone other than a patient of the covered entity, which is commonly referred to as “diversion.” HRSA has defined a covered entity patient through an October 24, 1996 Federal Register notice available on OPA's website.

What is Section 340B A )( 4 of the Public Health Service Act?

Section 340B(a)(4) of the PHS Act defines the types of entities eligible to participate in the 340B Program. Section 340B(a)(4)(L) states that a subset of Medicare disproportionate share hospitals (DSHs), as defined in section 1886(d)(1)(B) of the Social Security Act (SSA), are eligible for the 340B Program.

Is 340B Medicaid or Medicare?

The Issue. Section 340B of the Public Health Service Act requires pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at discounted prices to health care organizations that care for many uninsured and low-income patients.

What is the difference between Medicaid and 340B?

Medicaid was created to provide health care coverage for the poor and disabled, and 340B was created to stretch scarce federal resources to provide more care to more patients of safety-net hospitals.

For pdfFiller’s FAQs

What is Certification of Contract with State/Local Government to Provide Health Care Services?

It is a formal document that certifies that a provider has entered into a contract with a state or local government to deliver specified health care services.

Who is required to file Certification of Contract with State/Local Government to Provide Health Care Services?

Health care providers or organizations that have a contractual agreement with state or local governments to provide health care services are required to file this certification.

How to fill out Certification of Contract with State/Local Government to Provide Health Care Services?

To fill out the certification, providers must provide relevant details about the contract including the parties involved, the scope of services, and any applicable identification numbers or codes.

What is the purpose of Certification of Contract with State/Local Government to Provide Health Care Services?

The purpose is to ensure compliance with regulations, to verify eligibility for funding or reimbursement, and to maintain transparency in the provision of health care services.

What information must be reported on Certification of Contract with State/Local Government to Provide Health Care Services?

The report must include information such as the provider's details, the government agency involved, the terms of the contract, and descriptions of the services being provided.