Crosswalk: Contact Form
CMS-368 State Agency Contact Form_Crosswalk_10.2021.pdf
Medicaid Drug Rebate Program (MDRP): Quarterly State Invoice (CMS-R-144) and State Agency Contact Form (CMS-368)
Crosswalk: Contact Form
OMB: 0938-0582
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0582 can be found here:
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