Contract Supplier's Disclosure of = Subcontractors

CONTRACT SUPPLIER=E2=80=99S DISCLOSURE OF SUBCONTRACTORS

Consistent with Article VI of the Supplier Contract, provide the = information=20 below for each subcontractor(s). The Authorized Official must disclose = to the=20 Centers for Medicare & Medicaid Services (CMS) information on each=20 subcontracting relationship that the contract supplier has entered into = to=20 furnish items and services under its contract and whether each = subcontractor=20 meets the accreditation requirements in 42 CFR 424.57, if applicable. = This=20 information must be provided within 10 business days after final = contract=20 execution. For subcontracting arrangements entered into after contract = award,=20 the required disclosures must occur no later than 10 business days after = the=20 date the contract supplier enters into a subcontracting arrangement. = Please=20 visit the Competitive Bidding Implementation Contractor (CBIC) website = at www.dmecompetitivebid.com for information = regarding=20 applicable accreditation requirements for subcontractors.

Please provide the following information for the contract = supplier:

Provide the following information for the contract=20 supplier: * - denotes = required=20 fields
Bidder = Number*	Contract=20 Number*	PTAN*

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CONTRACT SUPPLIER=E2=80=99S DISCLOSURE OF SUBCONTRACTORS

Provide the following information for the contract=20 supplier:

Provide the following information for each=20 subcontractor:

Review Pending Changes