340B Class of Trade Alignment Monitoring Log
Log and monitor 340B class of trade alignment activities and observations efficiently.
Date of Entry
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Facility / Covered Entity Name
*
Contact Person
Product / Drug Name
*
Class of Trade Category
*
Please Select
Inpatient
Outpatient
Contract Pharmacy
Retail
Mail Order
Specialty
Other
Description of Alignment Issue or Observation
*
Corrective Action Taken
Current Status
*
Please Select
Open
In Progress
Resolved
Closed
Person Logging Entry
*
Additional Comments
Submit Log
Should be Empty: