Exit 340B Prescription Drug Program Survey 340B Prescription Drug Program Survey Question Title There have been recent actions taken by drug manufacturers that adversely impact the 340B Prescription Drug Program. KHA has been engaged in many activities related to this including advocating for our US House and Senate members to ask for action from HHS to halt some of the proposed actions by the drug manufacturers. In order to provide some quantitative data for our legislators, we would ask that you complete a short survey about your 340B program and the impact these changes may have specific to you. Please complete this survey by Friday, October 2. If you have any questions, please contact Steve Poage, spoage@kha-net.org, 785-276-3112 or Audrey Dunkel, adunkel@kha-net.org, 785-276-3116. Thanks! Question Title * Hospital Name: Question Title * Contact Name: Question Title * Contact Phone: Question Title * Contact E-mail: Question Title * 1) Impact by drug manufacturer if forced to move from multiple contract pharmacies to a single contract pharmacy: Astra Zeneca Eili Lilly Merck Novartis Sanofi Question Title * 2) Current number of contract pharmacies: Question Title * 3) Do you operate your own outpatient retail pharmacy? Yes No Question Title * 4) Total financial benefit of 340B program for your hospital for most recent fiscal year: Question Title * 5) Hospital Net Income for the past three completed fiscal years: Year Amount Year Amount Year Amount Question Title * 6) Do you operate a “cash pay” program alongside your 340B program? Yes No Thank you for taking the time to respond to this survey. Done