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Notice of 340B Program Participation Form for IHCP Managed Care Outpatient Drug Claims Note: This notice does not apply to Indiana Health Coverage Programs (IHCP) feeforservice (FFS) 340B program
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How to fill out notice of 340b program

01
Obtain a copy of the notice of 340b program form from the appropriate source.
02
Fill in all required information accurately, including the name of the covered entity and any related entities.
03
Provide details about the covered entity's eligibility for the 340b program, including the type of entity and its location.
04
Include information about the covered entity's contract pharmacy arrangements, if applicable.
05
Sign and date the notice of 340b program form before submitting it to the relevant authority.

Who needs notice of 340b program?

01
Covered entities participating in the 340b program need to fill out notice of 340b program to provide necessary information to the program administrators.
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The notice of 340b program is a requirement for covered entities participating in the 340B Drug Pricing Program to notify HRSA of their intent to participate in the program and comply with program requirements.
Covered entities such as hospitals, clinics, and health centers that participate in the 340B Drug Pricing Program are required to file notice of 340B program.
The notice of 340b program can be filled out online through HRSA's Electronic Handbooks (EHBs) system.
The purpose of the notice of 340b program is to ensure covered entities are aware of their obligations under the program and to provide HRSA with information on their participation.
The notice of 340b program must include information such as the covered entity's contact information, site details, and information about their pharmacy services.
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