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Effective Date:
12/2020Documents
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Document
Instructions
Updated: 12/2020
When to Prepare
Drug manufacturers wanting to participate in the CHIP Drug Rebate Program must complete two copies of this form and return both copies to the CHIP Drug Rebate Program administrator.
Transmittal
Staff sends the completed agreement to the CHIP Drug Rebate Program administrator:
Texas Contract Manager
Magellan Medicaid Administration
11311 Cornell Park Drive, Suite 102
Blue Ash, OH 45242