Get the free 340B Attestation Form and Instructions

Dear Provider: Per the Miss. Administrative Code, Title 23, Part 200, Rule 4.10, all covered entities, as defined in Section 340B of the Public Health Service Act, are required to notify the Division

How to fill out 340b attestation form and

How to fill out 340b attestation form:

1. Start by carefully reading the instructions provided with the form. This will give you a clear understanding of the information you need to provide and any specific guidelines to follow.
2. Begin by entering your organization's name, address, and contact information in the designated section of the form. Ensure accuracy and double-check for any typing errors.
3. Next, provide the necessary details about your organization's eligibility for the 340b program, such as the entity type (hospital, clinic, etc.), patient demographics, and any relevant certification or accreditation information.
4. Indicate whether your organization is participating in the 340b program through a contract pharmacy or an in-house pharmacy. Provide the necessary pharmacy-related details accordingly.
5. In the attestation section, carefully review the statements and select the appropriate response that reflects your organization's compliance with the program requirements. This may include confirming the use of 340b drugs for eligible patients and the implementation of internal controls to prevent diversion or duplicate discounts.
6. If applicable, provide any additional information requested or attach any supporting documentation as required by the form.
7. Before submitting the completed form, review all the provided information for accuracy and ensure that all necessary fields have been filled out.
8. Finally, sign and date the attestation form, confirming that the information provided is true and accurate to the best of your knowledge.

Who needs 340b attestation form:

1. Covered entities participating in the 340b Drug Pricing Program are required to complete the 340b attestation form. These entities include nonprofit and safety-net hospitals, health centers, clinics, and other eligible healthcare organizations.
2. The form serves as a declaration of compliance with the program requirements and is used to ensure the appropriate use of 340b drugs and prevent diversion or duplicate discounts.
3. Covered entities must fulfill this attestation annually to maintain their eligibility for the program and continue to benefit from the discounted pricing of 340b drugs. It is an essential requirement for participating in the program and demonstrating adherence to the program guidelines.

For pdfFiller’s FAQs

What is 340b attestation form and?

The 340B attestation form is a document that covered entities participating in the 340B Drug Pricing Program must complete to confirm compliance with program requirements.

Who is required to file 340b attestation form and?

Covered entities participating in the 340B Drug Pricing Program are required to file the 340B attestation form.

How to fill out 340b attestation form and?

The 340B attestation form can be filled out by providing accurate information about the covered entity's compliance with program requirements.

What is the purpose of 340b attestation form and?

The purpose of the 340B attestation form is to ensure that covered entities are following program requirements and are eligible to receive discounted drug pricing.

What information must be reported on 340b attestation form and?

The 340B attestation form may require information such as the covered entity's patient mix, compliance with program rules, and contract pharmacy arrangements.

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