Form 1343, CSHCN Rebate Agreement

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Documents

Effective Date: 4/2023

 

Instructions

Updated: 04/2023

 

When to Prepare

Drug manufacturers wanting to participate in the Children with Special Health Care Needs (CSHCN) Services Program Drug Rebate Program must complete two copies of this form and return both copies to the CSHCN Services Program.

 

Transmittal

Staff sends the completed agreement to the CSHCN Services Program:

Children with Special Health Care Needs Services Program 
CSHCN Drug Rebates 
Mail Code 1938
P.O. Box 149030 
Austin, TX 78714-9947

Or our physical address for overnight mail:

Children with Special Health Care Needs Services Program
CSHCN Drug Rebates
701 W. 51st Street, Mail Code 1938
Austin, TX 78714-9947