Attachment 4f South Dakota Medicaid Pricing Schedule.pdf

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Attached to
VISN 23 36C26320R0126 0008 Updated Fargo and Central Iowa Needed Counties List, Medicaid-based Open & Continuous Solicitation, Closing Date 04 March 2023
Solicitation number
36C26320R01260003
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Level of Care-LOC C-M WT Direct Care Non-Direct

Medicaid VA Contract Daily Drug Costs

SE3

SE2

SE1

RAD

RAC

RAB

RAA

SSC

SSB

SSA

CC2

CC1

CB2

CB1

CA2

CA1

IB2

IB1

IA2

IA1

BB2

BB1

BA2

BA1

PE2

PE1

PD2

PD1

PC2

PC1

PB2

PB1

PA2

PA1

South Dakota Medicaid Rates

Insert Direct & Non-Direct Rates Here:

11/25/2020

Attachment 4f: South Dakota Medicaid Pricing Schedule

Sheet1

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