Form 1337, CHIP Drug Rebate Agreement

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Effective Date: 12/2020



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.



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