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Quarterly Utilization Report (CMS-R-144)
Medicaid Drug Rebate Program (MDRP): Quarterly State Invoice (CMS-R-144) and State Agency Contact Form (CMS-368)
OMB: 0938-0582
IC ID: 212418
OMB.report
HHS/CMS
OMB 0938-0582
ICR 202404-0938-010
IC 212418
( )
Documents and Forms
Document Name
Document Type
Form CMS-R-144
Quarterly Utilization Report (CMS-R-144)
Form
CMS-R-144 Medicaid Drug Rebate Invoice
CMS-R-144 State Invoice_10.2021_Final.pdf
Form
CMS-R-144 State Invoice_Data Definitions_10.2021_Final.pdf
Instruction
Invoice Process Instructions_10.2021_Final.pdf
Instruction
CMS-R-144 State Invoice_Record Format_10.2021_Final.pdf
Instruction
CMS-R-144 State Invoice_Data Definitions_Crosswalk_10.2021.pdf
Crosswalk: Data Definitions
IC Document
Information Collection (IC) Details
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