DHR25006-PBM-att29.xlsx

XLSX spreadsheet 116 KB Posted Jul 15, 2025

Attached to: Pharmacy Benefit Management Services
Solicitation number: DHR25006-PBM
Issued by: Kent County, Delaware

About this file

Written by GovTribe AI · Jul 1, 2025

This document is a Post Adjudication Standard Layout file prepared by CVS Caremark, based on the National Council for Prescription Drug Programs (NCPDP) standard, dated May 28, 2010, and revised on 09/12/17. The file contains a detailed technical specification for processing pharmaceutical claims, with comprehensive fields covering patient information, prescription details, pharmacy data, and financial transaction information. The layout includes header, detail, and trailer records with precise definitions for each data field, ranging from record types and version numbers to specific claim-related attributes like patient demographics, prescription characteristics, and payment details.

The file provides an exhaustive breakdown of claim processing parameters, including fields for tracking patient information, pharmacy identifiers, drug details, dosage forms, and financial transactions. It includes specific codes for various scenarios such as prescription origin, other coverage indicators, reject codes, and drug categorizations. The document also contains exhibits detailing reject codes and drug dosage form codes, which serve as reference materials for claims processing. The technical specification appears designed to standardize and streamline pharmaceutical claims processing across different healthcare systems and insurance providers, with a focus on detailed, structured data capture and transaction tracking.

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DHR25006-PBM-its.pdf	PDF	Jul 15, 2025
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D.0 Post Adjudication Standard Descriptions and Values for Mandatory and Caremark selected fields

PAL4KD0 4000 Bytes

Prepared by CVS Caremark - May 28, 2010

Revised 09/12/17

Preface

The fields selected in this layout are based upon the NCPDP Post Adjudicated Standard Layout. Should

you require a copy of the proprietary NCPDP inplementation guide please contact NCPDP at:

National Council for Prescription Drug Programs

9240 East Raintree Drive

Scottsdale, AZ 85260

(480) 477-1000 fax (480) 767-1024

www.ncpdp.org

Page &P http://www.ncpdp.org/ CMK PA History Header Record

Post Adjudication History Header Record
Field #	Field Name	Format	Size	Start	End	Description/Values
1	Record Type	A/N	2	1	2	PA = PA History Header Record

2	Version/Release Number	A/N	2	3	4	10 = Post Adjudication 3.0 version
3	Sending Entity Identifier	A/N	24	5	28	Caremark
4	Batch Number	N	7	29	35	Julian Date

Format CCYYDDD

5	Creation Date	N	8	36	43	Format CCYYMMDD
6	Creation Time	N	4	44	47	Format HHMM

HH = Hour MM = Minute

7	Receiver ID	A/N	24	48	71	CVS Caremark Client Name
8	Reporting Period Start Date	N	8	72	79	The first day of the period being reported in the file.

Format: CCYYMMDD 9 Reporting Period End Date N 8 80 87 The last day of the period being reported in the file.

Format: CCYYMMDD 10 File Type A/N 1 88 88 Identifies that the data to be applied is a test or prodution file.

Values:

P = Production 11 Transmission Action A/N 1 89 89 O = Original Submission (New)

12 Submission Number A/N 2 90 91 Indicates the number of times a data set has been resent.

Values:

Blank = Not Specified 00 = Original Submission 13 Filler A/N 3909 92 4000 Spaces

Page &P

CMK PA History Detail Record

Post Adjudication History Detail Record
Field #	Field Name	Format	Size	Start	End	Description/Values	Overpunch
1	Record Type	A/N	2	1	2	DE = PA History Detail Record

2 Record Indicator A/N 1 3 3 Action to be taken on the record.

Values:

Blank = Not Specified 0 = New record

3	Filler	A/N	3	4	6	Space Filled
4	Final Plan Qualifier	A/N	10	7	16	Adjudicated plan qualifier code
5	Filler	A/N	10	17	26	Space Filled
6	Filler	A/N	15	27	41	Space Filled
7	Filler	A/N	6	42	47	Space Filled
8	Filler	A/N	20	48	67	Space Filled
9	Filler	A/N	20	68	87	Space Filled
10	Filler	A/N	200	88	287	Space Filled
11	Cardholder ID	A/N	20	288	307	The member ID as provided by the client on the enrollment feed.
12	Last Name	A/N	35	308	342	The last name of the cardholder. The value as provided by the client on the enrollment feed.
13	First Name	A/N	25	343	367	The first name of the cardholder. The value as provided by the client on the enrollment feed.
14	Middle Initial	A/N	1	368	368	The middle initial of the cardholder. The value as provided by the client on the enrollment feed.
15	Filler	A/N	10	369	378	Space Filled
16	Filler	A/N	55	379	433	Space Filled
17	Filler	A/N	55	434	488	Space Filled
18	Filler	A/N	30	489	518	Space Filled
19	Filler	A/N	2	519	520	Space Filled
20	Filler	A/N	15	521	535	Space Filled
21	Cardholder Date of Birth	N	8	536	543	The date of birth of the cardholder. The value as provided by the client on the enrollment feed.

Format CCYYMMDD

22	Filler	N	1	544	544	Zero Filled
23	Filler	A/N	1	545	545	Space Filled
24	Filler	A/N	1	546	546	Space Filled
25	Filler	A/N	2	547	548	Space Filled
26	Filler	A/N	20	549	568	Space Filled
27	Patient Last Name	A/N	35	569	603	The last name of the patient associated to the claim. The value as provided by the client on the enrollment feed.
28	Patient First Name	A/N	25	604	628	The first name of the patient associated to the claim. The value as provided by the client on the enrollment feed.
29	Patient Middle Initial	A/N	1	629	629	The middle initial of the patient associated to the claim. The value as provided by the client on the enrollment feed.
30	Filler	A/N	10	630	639	Space Filled
31	Filler	A/N	55	640	694	Space Filled
32	Filler	A/N	55	695	749	Space Filled
33	Filler	A/N	30	750	779	Space Filled
34	Filler	A/N	2	780	781	Space Filled
35	Filler	A/N	15	782	796	Space Filled
36	Patient Date of Birth	N	8	797	804	The date of birth of the patient that the claim processed against. The value as provided by the client on the enrollment feed.

Format CCYYMMDD 37 Patient Gender Code N 1 805 805 The gender of the patient that the claim processed against. The value as provided by the client on the enrollment feed.

Values:

1 = Male 2 = Female 0 = Not Specified 38 Eligibility/Patient Relationship Code N 2 806 807 The relationship code of the patient that the claim processed against. Values:

00 = Non Applicable 01 = Spouse 18 = Self 19 = Child 23 = Sponsored Dependent

39	Patient Age	N	3	808	810	Format = YYY
40	Filler	A/N	3	811	813	Space Filled
41	Filler	N	1	814	814	Zero Filled
42	Filler	A/N	1	815	815	Space Filled
43	Filler	A/N	10	816	825	Space Filled
44	Group ID	A/N	15	826	840	ID assigned to the cardholder group or employer group.
45	Carrier Number	A/N	9	841	849	Populated with the carrier ID associated to the patient at the time the prescription was filled.
46	Filler	A/N	15	850	864	Space Filled
47	Filler	A/N	8	865	872	Space Filled
48	Filler	A/N	1	873	873	Space Filled
49	Filler	A/N	1	874	874	Space Filled
50	Filler	A/N	1	875	875	Space Filled
51	Filler	A/N	1	876	876	Space Filled
52	Filler	A/N	1	877	877	Space Filled
53	Filler	A/N	10	878	887	Space Filled
54	Filler	A/N	1	888	888	Space Filled
55	Filler	A/N	10	889	898	Space Filled
56	Other Coverage Code	N	2	899	900	Values: 00 or 01 = Primary claim can be either COB segment or copay only 02 = Secondary claim - OPAP, Segment billing 03 = Reject in Primary - drug not covered 04 = Other coverage exists, payment not collected - deductible 05 = Reject in Primary - Managed Care plan denial 06 = Reject in Primary - Not a participating provider 07 = Reject in Primary - Other coverage exists - not in effect at time of service 08 = Secondary claim - OACS - copay only billing
57	Filler	A/N	2	901	902	Space Filled
58	Filler	A/N	4	903	906	Space Filled
59	Service Provider ID Qualifier	A/N	2	907	908	Populated with the provider qualifier value associated to the pharmacy. Values: Blank = Not Specified

01 = National Provider Identifier (NPI) 02 = Blue Cross 03 = Blue Shield 04 = Medicare 05 = Medicaid

06 = UPIN

07 = NCPDP Provider ID 08 = State License 09 = Champus 10 = Health Industry Number (HIN) 11 = Federal Tax ID 12 = Drug Enforcement Agency (DEA) 13 = State Issued 14 = Plan Specific 99 = Other

60	Service Provider ID	A/N	15	909	923	Populated with the dispensing provider ID number.
61	Filler	A/N	2	924	925	Space Filled
62	Filler	A/N	15	926	940	Space Filled
63	Filler	N	7	941	947	Zero Filled
64	Pharmacy Name	A/N	35	948	982	The name of the dispensing provider.
65	Pharmacy Address Line 1	A/N	55	983	1037	The address of the dispensing provider.
66	Pharmacy Address Line 2	A/N	55	1038	1092	The address of the dispensing provider.
67	City	A/N	30	1093	1122	The city of the dispensing provider.
68	State	A/N	2	1123	1124	The state of the dispensing provider.
69	Zip	A/N	15	1125	1139	The zip of the dispensing provider.
70	Filler	A/N	3	1140	1142	Space Filled
71	Pharmacy Telephone Number	N	10	1143	1152	The telephone number of the dispensing pharmacy.
72	Pharmacy Dispenser Type	A/N	2	1153	1154	RxClaim client Values (Type of pharmacy dispensing product is based on the RCPADP file):

1 = Retail 2 = Grocery Store 3 = Department Store 4 = Long Term Care 5 = Mail Order 6 = IV Infusion 7 = Dispensing Physician 8 = Indian Health Services 9 = VA Hospital 10 = State Hospital 11 = Institution 12 = HMO Pharmacy

13= DME

14 = Clinic Pharmacy 15 = Specialty 16 = Nuclear 17 = Military 18 = Compounding 0 = Other

73	Filler	A/N	1	1155	1155	Space Filled
74	Filler	A/N	1	1156	1156	Space Filled
75	Network Reimbursement ID	A/N	10	1157	1166	Pharmacy network identifier.
76	Prescriber ID Qualifier	A/N	2	1167	1168	Populated with the qualifier value associated to the prescriber. Values:

Blank = Not Specified 01= National Provider Identifier (NPI) 02 = Blue Cross 03 = Blue Shield 04 = Medicare 05 = Medicaid

06 = UPIN

07 = NCPDP Provider ID 08 = State License 09 = Champus 10 = Health Industry Number (HIN) 11 = Federal Tax ID 12 = Drug Enforcement Agency (DEA) 13 = State Issued 14 = Plan Specific 99 = Other

77	Prescriber ID	A/N	15	1169	1183	Populated with the prescriber ID submitted on the claim transaction by the pharmacy.
78	Filler	A/N	2	1184	1185	Space Filled
79	Filler	A/N	15	1186	1200	Space Filled
80	Filler	A/N	3	1201	1203	Space Filled
81	Filler	A/N	10	1204	1213	Space Filled
82	Filler	A/N	2	1214	1215	Space Filled
83	Prescriber Last Name	A/N	35	1216	1250	The prescriber's last name as submitted by the pharmacy.
84	Prescriber First Name	A/N	25	1251	1275	The prescriber's first name as submitted by the pharmacy.
85	Filler	N	10	1276	1285	Zero Filled
86	Filler	A/N	2	1286	1287	Space Filled
87	Filler	A/N	15	1288	1302	Space Filled
88	Filler	A/N	3	1303	1305	Space Filled
89	Filler	A/N	35	1306	1340	Space Filled
90	Filler	A/N	25	1341	1365	Space Filled
91	Record Status Code	A/N	1	1366	1366	Identifies the transaction status as assigned by the processor.

Values:

Blank = Not Specified 1 = Paid 2 = Rejected 3 = Reversed 4 = Adjusted 5 = Captured 6 = Reverse Captured 92 Claim Media Type A/N 1 1367 1367 Claim submission type code.

Values:

Blank = Not Specified 1 = POS Claim 2 = Batch Claim 3 = Pharmacy Submitted Paper Claim (UCF) 4 = Member Submitted Paper Claim (DMR) 5 = Other

93	Filler	A/N	2	1368	1369	Space Filled
94	Filler	A/N	1	1370	1370	Space Filled
95	Filler	N	9	1371	1379	Zero Filled
96	Product/Service ID Qualifier	A/N	2	1380	1381	Populated with the product ID qualifier associated to the product dispensed.

Values:

Blank/00 = Not Specified 01 = Universal Product Code (UPC) 02 = Health Related Item (HRI) 03 = National Drug Code (NDC) 04 = Universal Product Number (UPN) 05 = Department of Defense (DOD) 06 = Drug Use Review/Professional Pharmacy Service (DUR/PPS) 07 = Common Procedure Terminology (CPT4) 08 = Common Procedure Terminology (CPT5) 09 = Health Care Financing Administration Common Procedural Coding System (HCPCS) 10 = Pharmacy Practice Activity Classification (PPAC) 11 = National Pharmaceutical Product Interface Code (NAPPI) 12 = International Article Numbering System (EAN) 13 = Drug Identification Number (DIN) 99 = Other 97 Product/Service ID A/N 19 1382 1400 Populated with the product ID for the product dispensed.

Format = MMMMMDDDDPP 98 Date of Service N 8 1401 1408 Identifies the date the prescription was filled or professional service rendered.

Format = CCYYMMDD 99 Adjudication Date N 8 1409 1416 Date the claim or adjustment is processed.

Format = CCYYMMDD

100	Filler	N	6	1417	1422	Zero Filled
101	Filler	N	8	1423	1430	Zero Filled
102	Filler	N	5	1431	1435	Zero Filled
103	Cycle End Date	N	8	1436	1443	Cycle End Date. Populated with the run through date of the file.

Format = CCYYMMDD

104	Filler	A/N	2	1444	1445	Space Filled
105	Filler	N	2	1446	1447	Zero Filled
106	Filler	N	1	1448	1448	Zero Filled
107	Filler	N	8	1449	1456	Zero Filled
108	Filler	N	8	1457	1464	Zero Filled
109	D.0 RX NUMBER	N	15	1465	1479	HIPAA D.0 Reference Number assigned by the provider for the dispensed drug/product and/or service provided.
110	RX NUMBER QUALIFIER	A/N	1	1480	1480	Indicates the type of billing submitted.

Values:

1 = Rx Billing 2 = Service Billing

	111	Filler	A/N	1	1481	1481	Space Filled
	112	Filler	N	8	1482	1489	Zero Filled
	113	Filler	A/N	30	1490	1519	Space Filled
	114	Filler	N	9	1520	1528	Zero Filled
	115	Filler	N	8	1529	1536	Zero Filled
	116	Quantity Dispensed	N	10	1537	1546	Quantity dispensed expressed in metric decimal units.
Format = 9999999.999	Yes
	117	Fill Number	N	2	1547	1548	The code indicating whether the prescription is an original or a refill. Values:

0 = Original dispensing 1 to 99 = Refill number

118	Days Supply	A/N	3	1549	1551	Estimated number of days the prescription will last.	Yes
119	Date Prescription Written	A/N	8	1552	1559	Date the prescription was written.

Format = CCYYMMDD 120 Dispense as Written (DAW)/Product Selection Code A/N 1 1560 1560 Code indicating whether or not the prescriber's instructions regarding generic substitution were followed. Values:

0 = No Product Selection Indicated 1 = Substitution Not Allowed by Prescriber 2 = Substitution Allowed - Patient Requested Product Dispensed.

3= Substitution Allowed - Pharmacist Selected Product Dispensed.

4 = Substitution Allowed - Generic Drug Not in Stock 5 = Substitution Allowed - Brand Drug Dispensed as a Generic.

6 = Override 7 = Substitution Not Allowed - Brand Drug Mandated by Law 8 = Substitution Allowed - Generic Drug Not Available in Marketplace 9 = Other 121 Number of Refills Authorized N 2 1561 1562 The number of refills authorized. Values:

0 = Not specified 1 thru 99, with 99 being as needed, refills unlimited.

122	Filler	N	1	1563	1563	Zero Filled
123	Unit of Measure	A/N	2	1564	1565	NCPDP Standard Product billing codes.

EA = Each GM = Grams ML = Milliliters

124	Filler	N	2	1566	1567	Zero Filled
125	Filler	A/N	1	1568	1568	Space Filled
126	Original Quantity	N	10	1569	1578	The original input quantity. If any reductions or corrections to quantity take place, refer to field 116 Quantity Dispensed. This field remains fixed. Submitted on the claim by the pharmacy in metric units.	Yes
127	Filler	N	10	1579	1588	Zero Filled
128	Original Day Supply	N	3	1589	1591	Pharmacy submitted days supply. If any reductions or corrections to day supply take place, refer to field 118 Day Supply. This field remains fixed.	Yes
129	Filler	N	2	1592	1593	Zero Filled
130	Compound Code	N	1	1594	1594	Code indicating whether or not the prescription is a compound. Values:

0 = Not Specified 1 = Not a Compound 2 = Compound

131	Filler	N	2	1595	1596	Zero Filled
132	Diagnosis Code Qualifier	A/N	2	1597	1598	Code qualifying the submitted diagnosis code.

Blank or 00 = Not Specified

01 = ICD-9

02 = ICD-10

133	Diagnosis Code	A/N	15	1599	1613	Diagnosis code as submitted with the claim transaction. As it is not needed for adjudication, may frequently be blank.
134	Filler	A/N	2	1614	1615	Space Filled
135	Filler	A/N	15	1616	1630	Space Filled
136	Filler	A/N	2	1631	1632	Space Filled
137	Filler	A/N	15	1633	1647	Space Filled
138	Filler	A/N	2	1648	1649	Space Filled
139	Filler	A/N	15	1650	1664	Space Filled
140	Filler	A/N	2	1665	1666	Space Filled
141	Filler	A/N	15	1667	1681	Space Filled
142	Filler	A/N	2	1682	1683	Space Filled
143	Filler	A/N	2	1684	1685	Space Filled
144	Filler	A/N	2	1686	1687	Space Filled
145	Filler	N	2	1688	1689	Zero Filled
146	Filler	A/N	2	1690	1691	Space Filled
147	Filler	A/N	2	1692	1693	Space Filled
148	Filler	A/N	2	1694	1695	Space Filled
149	Filler	N	2	1696	1697	Zero Filled
150	Filler	A/N	2	1698	1699	Space Filled
151	Filler	A/N	2	1700	1701	Space Filled
152	Filler	A/N	2	1702	1703	Space Filled
153	Filler	N	2	1704	1705	Zero Filled
154	Filler	A/N	2	1706	1707	Space Filled
155	Filler	A/N	2	1708	1709	Space Filled
156	Filler	A/N	2	1710	1711	Space Filled
157	Filler	N	2	1712	1713	Zero Filled
158	Filler	A/N	2	1714	1715	Space Filled
159	Filler	A/N	2	1716	1717	Space Filled
160	Filler	A/N	2	1718	1719	Space Filled
161	Filler	N	2	1720	1721	Zero Filled
162	Filler	A/N	2	1722	1723	Space Filled
163	Filler	A/N	2	1724	1725	Space Filled
164	Filler	A/N	2	1726	1727	Space Filled
165	Filler	N	2	1728	1729	Zero Filled
166	Filler	A/N	2	1730	1731	Space Filled
167	Filler	A/N	2	1732	1733	Space Filled
168	Filler	A/N	2	1734	1735	Space Filled
169	Filler	N	2	1736	1737	Zero Filled
170	Filler	A/N	2	1738	1739	Space Filled
171	Filler	A/N	2	1740	1741	Space Filled
172	Filler	A/N	2	1742	1743	Space Filled
173	Filler	N	2	1744	1745	Zero Filled
174	Filler	A/N	2	1746	1747	Space Filled
175	Filler	A/N	2	1748	1749	Space Filled
176	Filler	A/N	2	1750	1751	Space Filled
177	Filler	N	2	1752	1753	Zero Filled
178	Filler	A/N	2	1754	1755	Space Filled
179	Filler	A/N	19	1756	1774	Space Filled
180	Filler	A/N	1	1775	1775	Space Filled
181	Reject Code 1	A/N	3	1776	1778	The first reject code associated to the claim if it was rejected (denied). Only available when requested to be populated. See Exhibit A for denial codes.
182	Reject Code 2	A/N	3	1779	1781	The second reject code associated to the claim if it was rejected (denied).

Only available when requested to be populated. See Exhibit A for denial codes.

183 Reject Code 3 A/N 3 1782 1784 The third reject code associated to the claim if it was rejected (denied).

Only available when requested to be populated. See Exhibit A for denial codes.

184	Filler	A/N	3	1785	1787	Space Filled
185	Filler	A/N	3	1788	1790	Space Filled
186	Filler	A/N	30	1791	1820	Space Filled
187	Filler	N	8	1821	1828	Zero Filled
188	Database Indicator	A/N	1	1829	1829	Code to define the database used for identifying the product.

Values:

Blank = Not Specified 1 = First DataBank 2 = Medi-Span Product Line 3 = Micromedex/Medical Economics 4 = Processor Developed 5 = Other 6 = Redbook 7 = Multum

189	Product/Service Name	A/N	30	1830	1859	Label or drug name associated to the product dispensed.
190	Generic Name	A/N	30	1860	1889	The name associated to the GPI or Generic name.
191	Product Strength	A/N	15	1890	1904	The strength of the product identified in the product code.
192	Dosage Form Code	A/N	4	1905	1908	Indicates the dosage form of the drug. See Exhibit B for dosage form codes.
193	Filler	A/N	6	1909	1914	Space Filled
194	Filler	A/N	2	1915	1916	Space Filled
195	Drug Type	N	1	1917	1917	Code to indicate the type of drug dispensed. Values:

0 = Not Specified 1 = Single source brand 2 = Branded generic 3 = Generic 4 = O.T.C (over the counter) 5 = Multi-source Brand 196 Maintenance Drug Indicator A/N 1 1918 1918 Indicates if the drug is a maintenance drug under the client's benefit plan.

Values:

Blank = Not Applicable Y = Maintenance Drug N = Not Maintenance 197 Drug Category Code A/N 1 1919 1919 Obtained from CVS Caremark drug database.

Values:

Blank = Not Specified

1 = INSULIN

2 = ORAL CONTRACEPTIVES

3 = SURGICAL SUPPLY/MEDICAL DEVICE/OSTOMY

4 = BLOOD COMPONENT

5 = DIAGNOSTIC AGENT

6 = GENERAL ANESTHETIC

7 = FERTILITY DRUGS

8 = ANOREXIC, ANTI-OBESITY

9 = MULTIPLE VITAMIN

A = USED FOR HIV INFECTION

C = COSMETIC ALTERATION DRUGS

D = ANTIDEPRESSANTS

F = MULTIPLE VITAMIN WITH FLUORIDE

G = GROWTH HORMONES/BIOSYNTHETIC HORMONES

H = HYPNOTICS/SEDATIVES

I = MULTIPLE VITAMIN WITH IRON

M = IMMUNOSUPPRESSANTS

P = ANTIPSYCHOTICS

S = SMOKING DETERRENTS

T = ANTIANXIETY AGENTS

K = NON ORAL SYSTEMIC CONTRACEPTIVES

L = CONTRACEPTIVES OTHER

B = BULK CHEMICALS

V = IMPOTENCE AGENTS

198	Filler	A/N	1	1920	1920	Space Filled
199	Filler	A/N	1	1921	1921	Space Filled
200	Denial Clarification Code	N	2	1922	1923	Code indicating that the pharmacist is clarifying the submission.

Values:

00 = Not Specified 01 = No Override 02 = Other Override 03 = Vacation Supply 04 = Lost Prescription 05 = Therapy Change 06 = Starter Dose 07 - Medically Necessary 08 = Process Compound For Approved Ingredients 09 = Encounters 99 = Other

201	Filler	N	2	1924	1925	Zero Filled
202	Filler	N	2	1926	1927	Zero Filled
203	Filler	A/N	1	1928	1928	Space Filled
204	GCN Number	A/N	6	1929	1934	GCN number associated to the drug dispensed. GCNs populated are those that are in the system at the time the file is run; not based on when the claim adjudicated.
205	Filler	A/N	6	1935	1940	Space Filled
206	Generic Product Identifier	A/N	14	1941	1954	Identifies the generic and therapeutic class of the drug dispensed.
207	Med B/ Med D Indicator	A/N	1	1955	1955	B = Med B drug

D = Med D drug Blank = neither

208	Filler	N	3	1956	1958	Zero Filled
209	Filler	N	2	1959	1960	Zero Filled
210	Filler	A/N	3	1961	1963	Space Filled
211	Filler	A/N	2	1964	1965	Space Filled
212	Therapeutic Class Code - AHFS	A/N	6	1966	1971	Identifies the pharmacological Therapeutic category of the product according to the American Hospital Formulary Service (AHFS) system.
213	Formulary Status	A/N	1	1972	1972	Indicates the Formulary status of the Drug.

Values:

Blank = Not Specified P = Drug on Formulary Q = Drug not on Formulary

214	Filler	A/N	1	1973	1973	Space Filled
215	Filler	A/N	8	1974	1981	Space Filled
216	Filler	A/N	15	1982	1996	Space Filled
217	Filler	A/N	1	1997	1997	Space Filled
218	Ingredient Cost Paid	N	8	1998	2005	The ingredient cost, based on quantity dispensed times unit cost.

Format = s$$$$$$cc

s9(6)v99	Yes
	219	Dispensing Fee Paid	N	8	2006	2013	Fee paid to the pharmacy for dispensing the drug. Format = s$$$$$$cc

s9(6)v99

Yes
220	Total Amount Paid by all Sources	N	8	2014	2021	Total amount of the prescription regardless of party responsible for payment.

(This field contains the sum of Net Amount Due (258) + any of the fields included in Patient Pay Amount (222). This calculation is exclusive of payments from other payers.)

Format = s$$$$$$cc

s9(6)v99	Yes
	221	Amount Attributed To Sales Tax	N	8	2022	2029	Amount that is due to total sales tax paid.

Format = s$$$$$$cc

s9(6)v99	Yes
	222	Patient Pay Amount	N	8	2030	2037	Amount that is calculated by the processor and returned to the pharmacy is the TOTAL amount to be paid by the patient to the pharmacy; the patient's total cost share, including copayments, amounts applied to deductible, over maximum amounts, penalties, etc.

Format = s$$$$$$cc

s9(6)v99	Yes
	223	Amount of Copay	N	8	2038	2045	Amount to be collected from the patient that is included in 'Patient Pay Amount' that is due to a per prescription copay.

Format = s$$$$$$cc

s9(6)v99	Yes
	224	Amount of Coinsurance	N	8	2046	2053	Amount to be collected from the patient that is included in 'Patient Pay Amount' that is due to a per prescription coinsurance. Format = s$$$$$$cc
s9(6)v99	Yes
	225	Amount Attributed To Product Selection	N	8	2054	2061	Amount to be collected from the patient that is included in Patient Pay Amount that is due to the patient's selection of drug product.

Format = s$$$$$$cc

s9(6)v99	Yes
	226	Amount Applied to Periodic Deductible	N	8	2062	2069	The amount to be collected from a patient that is applied to a periodic deductible.

Format = s$$$$$$cc s9(6)v99

Yes
227	Filler	N	8	2070	2077	Zero Filled
228	MAC Reduced Indicator	A/N	1	2078	2078	Indicates if a claim payment was reduced due to a MAC program.

Values:

Blank = Not applicable Y = Reduced to MAC pricing N = Not MAC Reduced 229 Client Pricing Basis of Cost A/N 2 2079 2080 Code indicating the method by which ingredient cost submitted is calculated based on client pricing. Values:

Blank = Not Specified

01 = AWP

1P = Pre-settlement AWP

02 = ACQ

03 = Manufacturer Direct Pricing 04 = Federal upper limit 05 = Average Generic Pricing 06 = U&C 07 = Submitted Ingredient Cost 08 = State MAC 09 = Unit 10 = U&C or Copay 230 Generic Indicator A/N 1 2081 2081 Distinguishes if product priced as Generic or Branded product: As defined by processor.

RxClaim client values:

M = Multi source branded product O = Brand Original N = Single source branded product Y = Generic product Z = Override generic indicator, price as "N" X = Price as "N", report as "Y" 231 Out of Pocket Apply Amount N 8 2082 2089 Total Patient Pay Amount. Same as Field 222.

Format = s$$$$$$cc s9(6)v99

Yes
232	Filler	N	9	2090	2098	Zero Filled
233	Filler	N	8	2099	2106	Zero Filled
234	AWP Type Indicator	A/N	1	2107	2107	A = AWP Pricing Used

P = PAWP Pricing Used 235 Average Wholesale Unit Price N 10 2108 2117 Populate the AWP or PAWP unit price of the medication based on how claim adjudicated. Refer to AWP Type Indicator.

Format = s$$$$$ccccc s9(5)v9(5)

Yes
236	Filler	N	3	2118	2120	Zero Filled
237	Average Wholesale Unit Price (Full)	N	17	2121	2137	Populate the AWP unit price. Provide full 17-byte value. Pending 9/22 release.	Yes
238	Filler	N	5	2138	2142	Zero Filled
239	Ingredient Cost Submitted	N	8	2143	2150	The submitted ingredient cost based on quantity dispensed times unit cost.

Format = s$$$$$$cc s9(6)v99

Yes
240	Usual & Customary Charge	N	8	2151	2158	Amount charged cash customers for the prescription exclusive of sales tax or other amounts claimed.

Format = s$$$$$$cc

s9(6)v99	Yes
	241	Flat Sales Tax Amount Paid	N	8	2159	2166	Amount to be collected from the patient that is included in Patient Pay Amount that is due to sales tax paid when a flat sales tax is used.

Format = s$$$$$$cc

s9(6)v99	Yes
	242	Percentage Sales Tax Amount Paid	N	8	2167	2174	Amount to be collected from the patient that is included in Patient Pay Amount that is due to sales tax paid when a percentage is used to calculate the sales tax.

Format = s$$$$$$cc

s9(6)v99	Yes
	243	Filler	N	7	2175	2181	Zero Filled
	244	Filler	A/N	2	2182	2183	Space Filled
	245	Filler	N	8	2184	2191	Zero Filled
	246	Filler	N	8	2192	2199	Zero Filled
	247	Filler	A/N	2	2200	2201	Space Filled
	248	Filler	N	8	2202	2209	Zero Filled	Yes
	249	Filler	A/N	2	2210	2211	Space Filled
	250	Filler	N	8	2212	2219	Zero Filled
	251	Filler	A/N	2	2220	2221	Space Filled
	252	Filler	N	8	2222	2229	Zero Filled
	253	Filler	N	8	2230	2237	Zero Filled
	254	Filler	A/N	1	2238	2238	Space Filled
	255	Filler	N	10	2239	2248	Zero Filled
	256	Filler	A/N	1	2249	2249	Space Filled
	257	Filler	N	10	2250	2259	Zero Filled
	258	Net Amount Due
(Total Amount Billed/Paid)	N	8	2260	2267	Net amount paid to provider by the payer or net amount due from the client to the payer. This is the Total Amount Billed/Paid.

Format = s$$$$$$cc

s9(6)v99	Yes
	259	Basis of Reimbursement Determination	N	2	2268	2269	Code identifying how the reimbursement amount was calculated for 'ingredient cost paid' (506-F6).

Values:

00 = Not Specified 01 = Ingredient Cost Paid as Submitted 02 = Ingredient Cost Reduced to AWP Pricing 03 = Ingredient Cost Reduced to AWP Less X% Pricing 04 = U&C Paid as Submitted 05 = Paid Lower of Ingredient Cost Plus Fees versus U&C 06 = MAC Pricing Ingredient Cost Paid 07 = MAC Pricing Ingredient Cost Reduced to MAC 08 = Contract Pricing 09 = Acquisition Pricing 14 = OPPR Amount (Other Payer-Patient Responsibility) 20 = Nat Avg Drug Acq Cost

	260	Accumulated Deductible Amount	N	8	2270	2277	Amount in dollars met by the patient/family in a deductible plan.
Format = s$$$$$$cc s9(6)v99	Yes
	261	Filler	N	8	2278	2285	Zero Filled
	262	Filler	N	8	2286	2293	Zero Filled
	263	Filler	N	8	2294	2301	Zero Filled
	264	Filler	N	8	2302	2309	Zero Filled
	265	Filler	N	8	2310	2317	Zero Filled
	266	Filler	N	8	2318	2325	Zero Filled
	267	Amount Exceeding Periodic Benefit Maximum	N	8	2326	2333	Amount to be collected from the patient that is included in patient pay amount (222) that is due to the patient exceeding a periodic benefit maximum.

Format = s$$$$$$cc

s9(6)v99	Yes
	268	Filler	A/N	2	2334	2335	Space Filled
	269	Basis of Calculation - Copay	A/N	2	2336	2337	Code identifying how the reimbursement amount was calculated for 'copay'.

Values:

270	Filler	A/N	2	2338	2339	Space Filled
271	Filler	A/N	2	2340	2341	Space Filled
272	Filler	A/N	2	2342	2343	Space Filled
273	Filler	A/N	1	2344	2344	Space Filled
274	Filler	N	8	2345	2352	Zero Filled
275	Filler	A/N	1	2353	2353	Space Filled
276	Filler	A/N	1	2354	2354	Space Filled
277	Filler	N	8	2355	2362	Zero Filled
278	Filler	N	8	2363	2370	Zero Filled
279	Filler	N	8	2371	2378	Zero Filled
280	Filler	A/N	1	2379	2379	Space Filled
281	Filler	N	4	2380	2383	Zero Filled
282	Filler	N	11	2384	2394	Zero Filled	Yes
283	Filler	N	2	2395	2396	Zero Filled
284	Filler	N	11	2397	2407	Zero Filled
285	Adjustment Issue ID	N	10	2408	2417	Internal CVS\|Caremark EAS Issue ID
286	Filler	N	1	2418	2418	Zero Filled
287	Processor Defined Prior Authorization Certification Code	N	2	2419	2420	Code submitted by the pharmacy to indicate the prior authorization certification code.

Values:

00 = Not Specified 01 = Prior Authorization 02 = Medical Certification

03 = EPSDT

04 = Exemption from Copay 05 = Exemption from Rx 06 = Family Plan Indicator

07 = TANF

08 = Payer Defined Exemption

288 Adjustment Reason Code A/N 3 2421 2423 11 - Not Specified

70 - LICS ADJUSTMENT

71 - LTC PATIENT PAY ADJUSTMENT

72 - CLAIM PAYMENT ADJUSTMENT

73 - MED D CLAIM PAYMENT ADJUSTMENT

74 - INTEREST PAYMENT

75 - AUTO-TROOP TRANSFER

76 - MANUAL TROOP TRANSFR

77 - PLAN DESIGN ADJUSTMENT

78 - CLAIM ADJUSTMENT- COB

79 - PHARM AUDIT RECOVERY DAILY

80 - CLAIM PAYMENT ADJUSTMENT

81 - PHARMACY COMPLIANCE FEE

82 - SALES TAX ADJUSTMENT

83 - MISC FEE BILLING ADJUSTMENT

84 - PHARMACY REQUESTED ADJUSTMENT

85 - PHARMACY ACKNOWLEDGED ADJ

86 - PHARMACY REQUESTED ADJUSTMENT

87 - FINANCIAL ASSISTANCE

88 - FINANCIAL ASST - RECOVERY

89 - PROCESSOR ERROR

90 - WRONG COPAY

91 - DISPENSING LIMITS

92 - WRONG CARRIER/GROUP

93 - PATIENT PAYS DIFF

94 - PAY DIFF OF CLM & PD

95 - OTHER

99 - CLAIM PAYMENT ADJUSTMENT

289	Filler	A/N	1	2424	2424	Space Filled
290	Filler	A/N	30	2425	2454	Space Filled
291	Filler	N	8	2455	2462	Zero Filled
292	Eligibility COB Indicator	A/N	1	2463	2463	Coordination of Benefits code as provided on Client eligibility.

Values:

Blank = Not specified 1 = Payer is primary 2 = Payer is secondary 3 = Payer is tertiary

293	Filler	A/N	1	2464	2464	Space Filled
294	Filler	A/N	10	2465	2474	Space Filled
295	Filler	N	8	2475	2482	Zero Filled
296	COB Primary Payer Amount Paid	N	8	2483	2490	Amount paid by primary payer for product or service. Format = s$$$$$$cc s9(6)v99	Yes
297	OPAR Amount	N	8	2491	2498	Other Payer Amount Received Format = s$$$$$$cc s9(6)v99	Yes
298	Filler	N	8	2499	2506	Zero Filled
299	COB Primary Payer Copay	N	8	2507	2514	Copay amount according to primary payer for product or service. Format = s$$$$$$cc s9(6)v99	Yes
300	Filler	A/N	10	2515	2524	Space Filled
301	Filler	N	8	2525	2532	Zero Filled
302	Filler	N	8	2533	2540	Zero Filled
303	Filler	N	8	2541	2548	Zero Filled
304	Filler	N	8	2549	2556	Zero Filled
305	Filler	N	8	2557	2564	Zero Filled
306	Transaction ID	A/N	30	2565	2594	Unique Claim Identifier (i.e., Doc#, RxClaim/Sequence #, BRT-ID/BRI-NB/Void Indicator)

The RxClaim/Sequence Number is for RxClaim clients and is defined as:

A unique number assigned by RxClaim based upon the following format: yyddssssshheee yy = The year submitted ddd = the julian date sssss = the number of seconds into the day hh = hundredths of seconds eee = the engine on which the claim was processed

The Sequence number of 999 is created along with the RxClaim number. The sequence number continues to increment down by one for every new paid or rejected transaction. If a claim is reversed, the reversal transaction retains both the same RxClaim identification of a paid-reversal combination.

307	Filler	A/N	20	2595	2614	Space Filled
308	Filler	A/N	9	2615	2623	Space Filled
309	Filler	A/N	4	2624	2627	Space Filled
310	Filler	A/N	5	2628	2632	Space Filled
311	Filler	A/N	2	2633	2634	Space Filled
312	Account ID	A/N	15	2635	2649	Populated with the RxClaim account ID associated to the patient at the time the prescription was filled. The definition varies from client to client.

If not applicable the field will be space filled.

313 Care Facility A/N 10 2650 2659 Populated with the RxClaim care facility ID associated to the patient at the time the prescription was filled. The definition varies from client to client.

If not applicable the field will be space filled.

314	Specialty RX Claim	A/N	1	2660	2660	Indicates if the claim is SpecialtyRx. 'N' = Claim was not invoiced as an SRx drug. 'Y' = Claim was invoiced as an SRx drug
315	Filler	A/N	1	2661	2661	Space Filled
316	Filler	A/N	3	2662	2664	Space Filled
317	Alternate ID	A/N	20	2665	2684	Cardholder Alternate ID. Only populated when Alternate ID is being used by the client.
318	Filler	A/N	1	2685	2685	Space Filled
319	Filler	A/N	1	2686	2686	Space Filled
320	Filler	A/N	1	2687	2687	Space Filled
321	Filler	A/N	1	2688	2688	Space Filled
322	Filler	A/N	1	2689	2689	Space Filled
323	Filler	A/N	8	2690	2697	Space Filled
324	Filler	A/N	21	2698	2718	Space Filled
325	Vaccine Administration Fee Paid	N	8	2719	2726	This field will be populated only for Vaccine + Administration fee claims or for Administration fee claims. Format = s$$$$$$cc S9(6)V99
Yes
326	Drug Admin Fee Type Code	A/N	1	2727	2727	This field will be populated only for Vaccine processing claims.

V = Vaccine only claims A = Admin fee only claims C = Vaccine & Admin fee claims Blank=For non Vaccine claims

327 Maintenance Choice Indicator A/N 1 2728 2728 This field will be populated if the claim paid using Maintenance Choice.

M = Claim paid using Maintenance Choice Blank = Non-Maintenance Choice Claim or Maintenance Choice N/A

	328	Applied HRA Amount	N	11	2729	2739	HRA amount. Format = S9(9)V99
If not applicable the field will be zero filled.	Yes
	329	CB5 Qualifier 1	A/N	2	2740	2741	Texas Medicaid Only
	330	CB5 OTH Amount 1	N	9	2742	2750	Texas Medicaid Only	Yes
	331	CB5 Qualifier 2	A/N	2	2751	2752	Texas Medicaid Only
	332	CB5 OTH Amount 2	N	9	2753	2761	Texas Medicaid Only	Yes
	333	CB5 Qualifier 3	A/N	2	2762	2763	Texas Medicaid Only
	334	CB5 OTH Amount 3	N	9	2764	2772	Texas Medicaid Only	Yes
	335	PD6 Client Total Other Amount	N	9	2773	2781	Texas Medicaid Only
	336	PD6 Buy Total Other Amount	N	9	2782	2790	Texas Medicaid Only	Yes
	337	Filler	A/N	1210	2791	4000	Space Filled

CMK PA History Trailer Record

Post Adjudication History Trailer Record
Field #	Field Name	Format	Size	Start	End	Description/Values	Overpunch
1	Record Type	A/N	2	1	2	PT = PA History Trailer Record

2	Total Record Count	N	10	3	12	The total number of records being submitted, including header and trailer in count.
3	Total Net Amount Due	N	12	13	24	Summarization of Net Amount Due (258)

Format s$$$$$$$$$$cc

s9(10)v99	Yes
	4	Filler	A/N	3976	25	4000	Spaces

Overpunch Characters

Overpunch Characters
Overpunch allows representation of positive and negatives in a numeric field without having to expand the size of the field for a plus or minus sign. The overpunch character replaces the right-most character in a numeric field. In a six-digit field, 99.95 would be represented as 00999E. In the same field, a negative 99.95 would be represented as 00999N. Lack of an overpunch character implies a positive amount - in other words, a positive 99.95 could be sent on the file as 009995.
	Number	Positive Overpunch	Negative Overpunch
	0	{	}
	1	A	J
	2	B	K
	3	C	L
	4	D	M
	5	E	N
	6	F	O
	7	G	P
	8	H	Q
	9	I	R

Exhibit A

EXHIBIT A: Reject Codes, RxClaim Clients
NCPDP Reject Codes applicable to fields 181 - 183, RxClaim clients
Code	Message	Code	Message	Code	Message
01	M/I Bin	50	Non-Matched Pharmacy	99	Host Processing Error
02	M/I Version Number	51	Non-Matched Group ID	CA	M/I Patient First Name
03	M/I Transaction Code	52	Non-Matched Cardholder ID	CB	M/I Patient Last Name
04	M/I Processor Control Number	53	Non-Matched Person Code	CC	M/I Cardholder First Name
05	M/I Pharmacy Number	54	Non-Matched NDC Number	CD	M/I Cardholder Last Name
06	M/I Group Number	55	Non-Matched NDC Pkg Size	CE	Home Plan Indicator
07	M/I Cardholder ID	56	Non-Matched Prescriber ID	CF	Employer Name
08	M/I Person Code	57	Non-Matched PA/MC Number	CG	Employer Address
09	M/I Birthdate	58	Non-Matched Primary Prescriber	CH	Employer City
10	M/I Sex Code	59	Non-Matched Clinic ID	CI	Employer State
11	M/I Relationship Code	60	(none)	CJ	Employer Zip
12	M/I Customer Location	61	(none)	CK	Employer Phone
13	M/I Other Coverage Cd	62	(none)	CL	Employer Contact
14	M/I Eligibility Override	63	(none)	CM	Patient Address
15	M/I Date Filled	64	(none)	CN	Patient City
16	M/I Rx Number	65	Patient not covered	CO	Patient State
17	M/I New-Refill Code	66	Patient age exceeds maximum	CP	Patient Zip
18	M/I Metric Quantity	67	Filled before coverage effective	CQ	Patient Phone number
19	M/I Days Supply	68	Filled after coverage expired	CR	Carrier ID
20	M/I Compound Code	69	Filled after coverage terminated	CT	Patient Social Security Number
21	M/I NDC Number	70	NDC not covered	DC	M/I Dispensing Fee
22	M/I Dispense as Written Code	71	Prescriber not covered	DP	M/I Drug type override
23	M/I Ingredient Cost	72	Primary Prescriber not covered	DQ	M/I U&C
24	M/I Sales Tax	73	Refills not covered	DR	M/I Doctor last name
25	M/I Prescriber ID	74	Patient pay exceeds payable	DS	M/I Postage amount
26	(none)	75	Prior Auth required	DT	M/I Unit dose indicator
27	(none)	76	Plan Limitations exceeded	DU	M/I Gross Amount
28	M/I Date Rx Written	77	Discontinued NDC	DV	M/I Other payor amount
29	M/I # Refills Authed	78	Cost exceeds maximum	DW	M/I Basis of days supply
30	M/I PA/MC Code & Nbr	79	Refill too soon	DX	M/I Patient paid amount
31	(none)	80	Drug-diagnosis mismatch	DY	Injury date
32	M/I Level of Service	81	Claim too old	DZ	Claim reference ID
33	M/I Rx Origin Code	82	Claim is post-dated	E1	Alternate product type
34	M/I Rx Denial Override	83	Duplicate paid/capture claim	E2	Alternate product code
35	M/I Primary Prescriber	84	Claim has not been paid/captured	E3	Incentive amount submitted
36	M/I Clinic Identification	85	Claim not processed	E4	DUR conflict code
37	(none)	86	Submit manual reversal	E5	DUR intervention code
38	M/I Basis of Cost	87	Reversal not processed	E6	DUR Outcome code
39	M/I Diagnosis code	88	DUR reject error	E7	Metric decimal quantity
40	Non network pharmacy	89	Rejected claim fees paid	E8	Other payor date
41	Submit bill to other payor	90	Host hung up	M1	Patient not covered
42	(none)	91	Host response error	M2	Recipient locked in
43	(none)	92	System/Host unavailable	M3	Host PA/MC error
44	(none)	93	Planned unavailable	M4	Prescription nbr/time
45	(none)	94	Invalid message	M5	Requires manual claim
46	(none)	95	(none)	M6	Host eligibility error
47	(none)	96	(none)	M7	Host drug file error
48	(none)	97	(none)	M8	Host provider file error
49	(none)	98	(none)	MZ	Error overflow
818	MA Not Covrd, Plan Exclsn
AD	Billing Provider not eligible to bill
R6	Prod/Service not appropriate for this location
7X	Day Supply Exceeds Plan Limits
EZ	Missing/Invalid Prescriber ID Qualifier
RE	Missing/Invalid Compound Produc ID Qualifier

Exhibit B EXHIBIT B: Drug Dosage Form Codes and Descriptions

Refer to Dosage Form Code, Field 192 (bytes 1905 - 1908)

Form	Description
AEPB	Arsl Pwdr-Breath Activate
AERO	Aerosol
AERB	Aerosol, Breath Activated
AERP	Aerosol, powder
AERS	Aerosol, solution
BAR	Bar
BEAD	Beads
CPEP	Cap Enteric Coated Part
CPDR	Capsule Delayed Release
CPEC	Capsule Enteric Coated
CPSP	Capsule Sprinkle
CP12	Capsule SR 12 HR
CP24	Capsule SR 24 HR
CPCR	Capsule, controlled rlse
CAPS	Capsule, conventional
CONC	Concentrate
CREA	Cream
CRYS	Crystals
DEVI	Device (not specified)
TEST	Diagnosis test(not spcfd)
DPRH	Diaphragm
DISK	Disk
DCHE	Douche, not specified
DCHP	Douche, powder
DCHS	Douche, solution
ELIX	Elixir
EMUL	Emulsion
ENEM	Enema
FILM	Film
FLAK	Flakes
EXTR	Fluid extract
FOAM	Foam
GAS	Gas
GEL	Gel (jelly)
SOLG	Gel Forming Solution
GRAN	Granules
GREF	Granules Effervescent
GUM	Gum
IMPL	Implant
INHA	Inhaler
INJ	Injection (not specd)
INST	Insert
IUD	Intrauterine device
KIT	Kit (multiple component)
LEAV	Leaves
LIQD	Liquid (Not spec'd)
LQCR	Liquid, cntrlld release
LPOP	Lozenge on a Handle
LOTN	Lotion
LOZG	Lozenge
MISC	Miscellaneous (Not specd)
NEBU	Nebulization solution
OCSY	Ocular System
OIL	Oil
OINT	Ointment
PACK	Pack
PADS	Pad
PSTE	Paste
PTCH	Patch
PTTW	Patch Twice Weekly
PTWK	Patch Weekly
PT24	Patch 24 HR
PT72	Patch 72 HR
PLLT	Pellet
POWD	Powder
PDEF	Powder Effervescent
PUDG	Pudding
RING	Ring
SHAM	Shampoo
SHEE	Sheet
SOLN	Solution
SOLR	Solution, when reconst'd
SPRT	Spirit
STCK	Stick
STRP	Strip
SUPP	Suppository
SUSP	Suspension
SUSR	Suspension, when reconst
SWAB	Swab
SYRP	Syrup
TABS	Tablet
TBDR	Tablet Delayed Release
TBDP	Tablet Dispersible
TBSO	Tablet Soluble
TB12	Tablet SR 12 HR
TB24	Tablet SR 24 HR
CHEW	Tablet, chewable
TBCR	Tablet, cntld release
TBEF	Tablet, effervescent
TBEC	Tablet, enteric coated
SUBL	Tablet, sublingual
TAMP	Tampon
TAPE	Tape
TAR	Tar
TINC	Tincture
TDSY	Transdermal system
TROC	Troche
WAFR	Wafer
WAX	Wax
WHIP	Whip
CAPA	Cap Abuse Deter
CPEA	Cap ER Deter
C12A	Cap 12HR Deter
C24A	Cap 24HR Deter
TABA	Tab Abuse Deter
TBEA	Tab ER Deter
T12A	Tab 12HR Deter
T24A	Tab 24HR Deter
THPK	Therapy Pack
CPPK	Cap Ther Pack
CDPK	CPDR Ther Pack
CEPK	CPER Ther Pack
C2PK	CP12 Ther Pack
C4PK	CP24 Ther Pack
TBPK	Tab Ther Pack
TDPK	TBDR Ther Pack
TPPK	TBDP Ther Pack
TEPK	TBER Ther Pack
T2PK	TB12 Ther Pack
T4PK	TB24 Ther Pack
LQPK	Liqd Ther Pack
SOPK	Soln Ther Pack
SUPK	Susp Ther Pack
PEN	Pen-injector
SOPN	Soln Pen-inj
SUPN	Susp Pen-inj
AUIJ	Auto-injector
SOAJ	Soln Auto-inj
SUAJ	Susp Auto-inj
JTAJ	Jet-injector
SOTJ	Soln Jet-inj
SUTJ	Susp Jet-inj
CART	Cartridge
SOCT	Soln Cartridge
SUCT	Susp Cartridge
PRSY	Prefilled Syr
SOSY	Soln Pref Syr
SUSY	Susp Pref Syr
CSER	Cap ER Sprinkle
CS12	CP12 Sprinkle
CS24	CP24 Sprinkle
PNKT	Pen-Injector Kit
AJKT	Auto-Injector Kit
JTKT	Jet-Injector Kit
CTKT	Cartridge Kit
PSKT	Prefilled Syringe Kit
SUER	Suspension ER
SRER	For Susp ER
EXHA	Exhaler
EXHP	Exhaler Powder
EXHL	Exhaler Liquid
EXHS	Exhaler Solution
EXHU	Exhaler Suspension
TB3D	Tab Disint Sol
TB3E	Tab Dis Sol ER
CSDR	Cap DR Sprinkle
CHER	Tablet ER Chew
TBDD	Tab DR Disp
TBED	Tab ER Disp

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File details come from the government source that posted it. Updated Jul 1, 2025.