Rural Referral Centers


Rural Referral Centers are high-volume acute care rural hospitals that treat a large number of complicated cases. The Centers for Medicare and Medicaid Services classifies hospitals as Rural Referral Centers. Rural Referral Centers are defined in Section 1886(d)(5)(C )(i) of the Social Security Act; requirements for Rural Referral Centers can be found at 42 CFR 412.96. For more information about Rural Referral Centers, see Rural Referral Center Fact Sheet (PDF – 645  KB).

Hospitals classified as Rural Referral Centers may be eligible to participate in the 340B Drug Pricing Program if they have a disproportionate share adjustment percentage equal to or greater than 8 percent for the most recently filed Medicare cost report and meet the requirements of 42 USC 256b(a)(4)(L)(i).

Rural Referral Centers may also register their outpatient clinics.


  1. Know your eligibility. Only nonprofit organizations with specific federal designations and/or funding are eligible to register with and be approved to purchase discounted drugs through the 340B Drug Pricing Program.
  2. Be aware of the latest registration dates and deadlines. The current registration periods are listed on the top right corner of this page, along with a link to the OPA database and registration forms. The registration forms are open only during the registration periods.
  3. Identify your Authorizing Official. This individual must be someone who can legally bind the organization to a contract, such as a CEO, COO, or CFO. This is the only person who may submit the 340B online registration. You may designate another employee (not a consultant or contractor) to serve as the primary contact.
  4. Identify your Government Official. If you are submitting a parent hospital registration, please review step 2 of the Hospital Registration Instructions for instructions on additional information that will be required during the online registration process.
  5. Prepare to complete registration in one session. You must complete the online registration in one session. Registrations left uncompleted will become inactive and close automatically. If this occurs you will need to start at the beginning of the process.
  6. Collect required information. Have all the necessary information on hand to ensure your Hospital registration will be accepted.
  7. Submit required documentation immediately upon completion of your registration.

If the information received from CMS is current and correct, submission of worksheets and trial balances is not required. If a more recently filed cost report is available, or the hospital otherwise submits changes to the pre-identified information, the required documents must be submitted on the same day the registration is submitted. For details, please refer to the Hospital Registration Instructions (PDF - 267 KB).



Hospital Registration Review Process


Date Last Reviewed:  September 2017

Registration Now

Register Start Date
January 1-15 April 1
April 1-15 July 1
July 1-15 October 1
October 1-15 January 1


Eligible in Multiple Categories

Hospitals that are eligible to participate in the 340B Drug Pricing Program in more than one category may select one. For example, a hospital that is both as a Disproportionate Share Hospital and a Sole Community Hospital may choose either type of eligibility and must abide by requirements and guidelines for that type of eligible organization/covered entity once enrolled.