(THIS SPREADSHEET SHOULD NOT BE USED TO CONFIRM 340B PARTICIPATION)

Disproportionate Share Hospitals & Their Disproportionate Share Adjustment Percentage (Excel)

The spreadsheet is provided to the Office of Pharmacy Affairs (OPA) by the Centers for Medicare and Medicaid Services (CMS) and is the official source used to verify a hospital’s DSH adjustment percentage. Hospitals appearing on the list with a DSH adjustment percentage of greater than 11.75% meet the adjustment percentage requirement to participate in the 340B program. However, there are other qualifying criteria that must also be met. For-profit hospitals are not eligible to participate in the 340B program.

Hospitals not appearing on the list and hospitals that appear on the list but have a DSH adjustment percentage less than 11.75% are ineligible to participate in the 340B program. If you wish to challenge the DSH adjustment percentage reported by CMS, please provide to OPA a copy of Worksheet E, Part A, line 4.03 from your most recently filed Medicare cost reporting period that indicates a disproportionate share adjustment percentage of greater than 11.75%. This Worksheet should be accompanied by a signed letter from the hospital’s Chief Financial Officer certifying the accuracy of the DSH adjustment percentage as reflected on Worksheet E. OPA will make a determination on eligibility based on a review of the information submitted.