Hospital Enrollment, Additions and Recertifcations

Enrollment and Re-Certification of Entities in the 340B Drug Pricing Program and Collection of Manufacturer Data to Verify 340B Drug Pricing Program Ceiling Price Calculations

OMB: 0915-0327

IC ID: 190345

Documents and Forms

Document Name Document Type
Form 1.1 Hospital Enrollment, Additions and Recertifcations Form
1.1 340B Registration DSH Parent.pdf 340B Registration DSH Parent..pdf Form
1.2 340B Registration Children's Hospital PED Parent.pdf 340B Registration PED Parent..pdf Form
1.3 340B Registration CAN Parent.pdf 340B Registration CAN Parent..pdf Form
1.4 340B Registration Hospital Outpatient Facility.pdf 340B Registration Hospital Outpatient Facility..pdf Form
1.5 340B Registration RRC and SCH Parent.pdf 340B Registration RRC and SCH Parent..pdf Form
1.6 340B Registration CAH Parent.pdf 340B Registration CAH Parent..pdf Form
1.7 340B Recertification DSH.pdf 340B Recertification DSH..pdf Form
1.8 340B Recertification SCH and RRC.pdf 340B Recertification SCH and RRC.pdf Form
1.9 340B Recertification PED.pdf 340B Recertification PED..pdf Form
1.10 340B Recertification CAH.pdf 340B Recertification CAH..pdf Form
1.11 340B Recertification CAN.pdf 340B Recertification CAN.pdf Form
340B Registration DSH.docx Registration DSH IC Document
340B Registration Children's Hospital.docx Registration PED IC Document
340B Registration Free Standing Cancer Hospital.docx Registration CAN IC Document
340B Registration Outpatient.docx Registration Outpatient IC Document
340B Registration SCH and RRC.docx Registration SCH and RRC IC Document
340B Registration CAH.docx REDLINE Registration CAH IC Document
Recert DSH.docx REDLINE Recert DSH IC Document
Recert RRC and SCH.docx REDLINE Recert SCH and RRC IC Document
Recert Childrens PED.docx REDLINE Recert PED IC Document
Recert CAH.docx REDLINE Recert CAH IC Document
Recert CAN.docx REDLINE Recert CAN IC Document