Crosswalk

CMS-368 Record SpecificationCrosswalk_2019.xlsx

Medicaid Drug Rebate Program Forms (CMS-368 and CMS-R-144)

Crosswalk

OMB: 0938-0582

Document [xlsx]
Download: xlsx | pdf
2019 (old version) 2017 (new version) Type of Change Reason for Change Burden Change
N/A State DUR Contact Information: (1) DUR State Contact Name (2) Email Address (3) Phone Number (4) Fax Number (5) Name of Fiscal Agent (if applicable) (6) Street Address (7) City (8) State (9) Zip Code Add To provide each state with the option to submit their state DUR contact information. Negligible as it is an optional field.
MEDICAID DRUG REBATE PROGRAM
STATE AGENCY CONTACT FORM

MEDICAID DRUG REBATE PROGRAM (MDRP)
and DRUG UTILIZATION REVIEW (DUR) PROGRAM
STATE AGENCY CONTACT FORM
Rev To clarify that the CMS-368 is for both the Medicaid Drug Rebate Program (MDRP) and the Drug Utiliztaion Review (DUR) Program N/A - Update to verbiage in an existing field.
STATE CONTACT MDRP STATE DDR CONTACT Rev To differentiate whether the contact information is for the Medicaid Drug Rebate Program (MDRP) or the Drug Utiliztaion Review (DUR) Program N/A - Update to verbiage in an existing field.
TECHNICAL CONTACT MDRP TECHNICAL CONTACT Rev To differentiate whether the contact information is for the Medicaid Drug Rebate Program (MDRP) or the Drug Utiliztaion Review (DUR) Program N/A - Update to verbiage in an existing field.
PROGRAM POLICY CONTACT MDRP POLICY CONTACT Rev To differentiate whether the contact information is for the Medicaid Drug Rebate Program (MDRP) or the Drug Utiliztaion Review (DUR) Program N/A - Update to verbiage in an existing field.
REBATE CONTACT MDRP REBATE CONTACT Rev To differentiate whether the contact information is for the Medicaid Drug Rebate Program (MDRP) or the Drug Utiliztaion Review (DUR) Program N/A - Update to verbiage in an existing field.
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File Modified0000-00-00
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