diff --git a/.github/infrastructure/conformance/azure/conf-test-azure-cosmosdb.bicep b/.github/infrastructure/conformance/azure/conf-test-azure-cosmosdb.bicep
index ac398242e..5a34591db 100644
--- a/.github/infrastructure/conformance/azure/conf-test-azure-cosmosdb.bicep
+++ b/.github/infrastructure/conformance/azure/conf-test-azure-cosmosdb.bicep
@@ -16,7 +16,7 @@ resource cosmosDb 'Microsoft.DocumentDB/databaseAccounts@2021-04-15' = {
   tags: confTestTags
   properties: {
     consistencyPolicy: {
-      defaultConsistencyLevel: 'Session'
+      defaultConsistencyLevel: 'Strong' // Needed by conformance test state.go
     }
     locations: [
       {
diff --git a/state/azure/cosmosdb/cosmosdb.go b/state/azure/cosmosdb/cosmosdb.go
index 9bce33ebe..023b92d8f 100644
--- a/state/azure/cosmosdb/cosmosdb.go
+++ b/state/azure/cosmosdb/cosmosdb.go
@@ -15,6 +15,7 @@ import (
 
 	"github.com/a8m/documentdb"
 	"github.com/agrea/ptr"
+	"github.com/google/uuid"
 	jsoniter "github.com/json-iterator/go"
 
 	"github.com/dapr/components-contrib/contenttype"
@@ -241,10 +242,10 @@ func (c *StateStore) Set(req *state.SetRequest) error {
 	options := []documentdb.CallOption{documentdb.PartitionKey(partitionKey)}
 
 	if req.ETag != nil {
-		var etag string
-		if req.ETag != nil {
-			etag = *req.ETag
-		}
+		options = append(options, documentdb.IfMatch((*req.ETag)))
+	}
+	if req.Options.Concurrency == state.FirstWrite && (req.ETag == nil || *req.ETag == "") {
+		etag := uuid.NewString()
 		options = append(options, documentdb.IfMatch((etag)))
 	}
 	if req.Options.Consistency == state.Strong {
@@ -295,11 +296,7 @@ func (c *StateStore) Delete(req *state.DeleteRequest) error {
 	}
 
 	if req.ETag != nil {
-		var etag string
-		if req.ETag != nil {
-			etag = *req.ETag
-		}
-		options = append(options, documentdb.IfMatch((etag)))
+		options = append(options, documentdb.IfMatch((*req.ETag)))
 	}
 	if req.Options.Consistency == state.Strong {
 		options = append(options, documentdb.ConsistencyLevel(documentdb.Strong))