If a covered entity site (340B ID) answers “yes” to the following question in 340B OPAIS, “At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?” the site must also provide each Medicaid state it plans to bill, and the billing number(s) it will list on the bill to the state. This only applies to Medicaid fee-for-service. Billing number(s) may include the billing provider’s national provider identifier (NPI) only, state-assigned Medicaid number only, or both the NPI and state-assigned Medicaid number. This information listed for each covered entity site (340B ID) in 340B OPAIS is used to generate a quarterly Medicaid Exclusion File, which is an official data source used by stakeholders to determine which covered entity sites bill Medicaid fee-for-service for 340B drugs.
For more information, contact the 340B Prime Vendor at 1-888-340-2787 or via email at ApexusAnswers@340bpvp.com.