How can 340B hospitals prevent Medicaid duplicate discounts with contract pharmacies in 2026?

Hospitals can avoid duplicate discounts by reconciling their HRSA Medicaid Exclusion File with contract pharmacy dispensing and managed care data. HRSA now expects weekly crosswalks of MEF entries, separate identifiers for carve-outs, and monthly exclusion audits to prove Medicaid claims were excluded from 340B replenishment.