Rebate Administration Forms

Reconciliation of State Invoice

• CMS 304
• cms.gov/regulations-and-guidancelegislationpaperworkreductionactof1995pra-listing/cms-304-and-304a

Prior Quarter Adjustment Statement

• CMS 304a
• cms.gov/regulations-and-guidancelegislationpaperworkreductionactof1995pra-listing/cms-304-and-304a

Manufacturer Contact Form (Magellan Medicaid Administration)

• providersynergies.com/services/medicaid/default.asp?content=ManufacturerContactForm