340B Provider Enrollment Guidance

Oct 07, 2022

Providers are required to answer 340B questions each time they enroll or update a service location. When 340B information on the service location is not correct, or left blank, drug claim lines from that service location will deny. Enrollment questions for 340B that are required are as follows:  

1. Are you participating in the 340B drug program? Y/N  

2. Is this a change in your current participation status? Y/N  

3. Effective date: Effective Date of your most recent fully-executed 340B Agreement/Memorandum of Understanding (MOU) (Date signed by MaineCare Representative)   

4. Have you signed and received a fully executed copy (signed by MaineCare) of the 340B Memorandum of Understanding (MOU)? Y/N  

5. Please indicate the effective date of the change to your participation status  

6. Termination Date: Enter a date that is 5 years from the 340B Agreement/MOU effective date used in #3  

7. HRSA 340B Identifier: This is the number on the HRSA website used to identify your enrollment with HRSA  

8. MOU Signer: Enter the name of the person who signed the 340B Agreement/MOU  

9. Position: Enter the person’s position who signed the 340B Agreement/MOU 

10. Have you carved out Medicaid patients? Y/N (answering “No” means you provide 340B drugs to MaineCare members, this should match the 340B Agreement/MOU selection for carving out Medicaid patients, and the HRSA response to this question)  

For questions, please contact the Provider Services Call Center 1-866-690-5585, option 2, or email.