340B Hospital Commitment to Good Stewardship Principles Submission Form

Hospital or Health System address/location

If you are a health system, please list the individual 340B hospitals within your organization that will commit to the stewardship principles. Please separate each hospital name with a comma and provide each hospital’s Medicare Provider Number after each hospital name and include their city and state.

Commitment Contact

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If you have questions, please contact us at 340Balliance@aha.org.

Please note that by signing this commitment you agree that your organizations’ name/s would be made public at a future date.