PRA Disclosure Statement
PRA Disclosure Statement Screenshot.png
Medicaid Payment for Prescription Drugs - Physicians and Hospital Outpatient Departments Collecting and Submitting Drug Identifying Information to State Medicaid Programs (CMS-10215)
PRA Disclosure Statement
OMB: 0938-1026
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1026 can be found here:
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