Medicare & Medicaid Services / Human Services / First DataBank / AMP / Health / Fiscal Operations Utah / WHEREAS / National Drug Code / Pharmaceutical Manufacturer / /
Event
Business Partnership / /
IndustryTerm
drug manufacturers / prescription drug products / designated auditors / supplemental rebates / public utilities / reasonable effort / /
Organization
Director Bureau of Coverage / Food and Drug Administration / Company Utah Department of Health Signator Title Company Address City / Pharmacy and Therapeutics Committee / Division of Medicaid and Health Financing / Health Care Financing Administration / Utah PDL / DUR Committee / State Medicaid Agency / Department of Health / Medicare / Medicaid / /
Effective January 1, 2012 Department Log # SUPPLEMENTAL REBATE AGREEMENT Company Name This Supplemental Rebate Agreement (“Agreement”) is dated as of this 1st day of January by____ and