Get the free State Maximum Allowed Cost Drug Pricing Review Request, F-00030,
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DEPARTMENT OF HEALTH SERVICES Division of Medicaid Services F-00030 04/2017 STATE OF WISCONSIN Wis. I certify that the price listed on the documentation reflects the AAC after rebates or discounts from the wholesaler / supplier. Pharmacists are required to submit documentation to substantiate their actual acquisition cost AAC and sign the certifying statement below. Name Contact Person SECTION II PRODUCT AND PRICE INFORMATION 9. NDC 11-Digit No. 10. Drug Name 11. Admin. Code DHS 107. 10 2...
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What is state maximum allowed cost?
The state maximum allowed cost is the maximum amount that can be charged for a specific service in a state.
Who is required to file state maximum allowed cost?
Healthcare providers and facilities are required to file state maximum allowed cost.
How to fill out state maximum allowed cost?
State maximum allowed cost can be filled out by submitting the necessary information online or through a designated form.
What is the purpose of state maximum allowed cost?
The purpose of state maximum allowed cost is to regulate and control the cost of healthcare services to ensure affordability and accessibility for the general public.
What information must be reported on state maximum allowed cost?
Information such as service details, cost breakdown, and provider information must be reported on state maximum allowed cost.
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