JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
WMPAA Industry ListServ
This form is for individuals currently employed in a Pharma-related Industry. WMPAA will use this for meeting notifications.
You are responsible for the accuracy of your information.
Companies interested in sending attendees to the annual WMPAA meeting must meet one of the following categories:
Pharmaceutical companies who participate in the Medicaid Drug Rebate Program (they must have a product on the market at the time of the registration deadline)
Device manufacturers that can provide evidence that 33% or more WMPAA states cover their products within their pharmacy program
Medicaid consultants
Medicaid fiscal agent or system representatives
Governmental representatives for pharmacy providers – must provide evidence that they actively participate with 33% or more of WMPAA states
Representatives for vendors who contract with Medicaid agencies
Associations who interact with Medicaid agencies
Any other attendees at the discretion of the chair
Independent Pharmacies are NOT eligible to attend unless they meet the above criteria (33% of WMPAA states)
This is NOT a registration form.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
New member or Updating Contact Information?
*
New Member
Updating Contact Information
Remove me from ListServ
First Name
*
Your answer
Last Name
*
Your answer
Current Employer
*
Your answer
Title
*
Your answer
List the WMPAA State(s) you cover
*
Your answer
Work Email Address
*
Your answer
Phone Number
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms