Form 1343, CSHCN Rebate Agreement

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Effective Date
01/2022
Document
1343.pdf (126.45 KB)

 

Instructions

Updated: 12/2020

 

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:

Office of Primary and Specialty Health
Health and Developmental Services
CSHCN Drug Rebate Program
1100 W. 49th St, Mail Code 1938
Austin, TX 78756