Form 1337, CHIP Drug Rebate Agreement

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Effective Date

12/2020

1337.pdf

Instructions

Updated: 03/2026

When to Prepare

Drug manufacturers wanting to participate in the CHIP Drug Rebate Program must complete two copies of this form and return both copies to the CHIP Drug Rebate Program administrator.

Transmittal

Staff sends the completed agreement to the CHIP Drug Rebate Program administrator:

optumrx_texas_chip_rates@optum.com

vdp-rebates@hhs.texas.gov