Form 1337, CHIP Drug Rebate Agreement

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Effective Date
12/2020
Document
1337.pdf (137 KB)

 

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