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.pdf 340B Registration Children's Hospital.pdf Form
1.3 340B Registration CAN Parent.pdf 340B Registration Free Standing Cancer.pdf Form
1.4 340B Registration Hospital Outpatient Facility.pdf 340B Registration- Outpatient Facility.pdf Form
1.5 340B Registration RRC and SCH Parent.pdf 340B Registration Rural Referral and Sole Community Hospitals.pdf Form
1.6 340B Registration CAH Parent.pdf 340B Registration-CAH.pdf Form
1.7 340B Recertification DSH.pdf 340B Recertification DSH.pdf Form
1.8 340B Recertification SCH and RRC.pdf 340B Recertification Sole-community; Rural-Referral centers.pdf Form
1.9 340B Recertification Childrens Hospital.pdf 340B Recertification Children's Hospital.pdf Form
1.10 340B Recertification CAH.pdf 340B Recertification-CAH.pdf Form
1.11 340B Recertification CAN.pdf 340B Recertification Free Standing Cancer.pdf Form
340B Registration Children's Hospital Redline.pdf 340B Registration Children's Hospital Redline IC Document
340B Registration DSH Parent Redline.pdf 340B Registration DSH Parent Redline IC Document
340B Registration Free Standing Cancer Redline.pdf 340B Registration Free Standing Cancer Redline IC Document
340B Registration- Outpatient Facility Redline.pdf 340B Registration- Outpatient Facility Redline IC Document
340B Registration Rural Referral and Sole Community Hospitals Redline.pdf 340B Registration Rural Referral and Sole Community Hospitals Redline IC Document
340B Registration-CAH Redline.pdf 340B Registration-CAH Redline IC Document