M190_AttachA_Mail_Order_Report_Format_w_instructions.xlsx

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TRICARE Pharmacy Program, Fourth Generation (TPharm4)
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HT9402-13-R-0001
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Attachment to CDRL M190 - Mail Order Report Format w instructions

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TPHARM - Mail Order

CONTRACTOR NAMEFOR THE MONTH OF ___________
SUB-CONTRACTOR NAME (if applicable)
TPHARM MAIL ORDER REPORT
PREVIOUS MONTH'SREPORTING MONTH'S
YEAR TO DATETHIS MONTH'SYEAR TO DATE
TOTALTRANSACTIONSTOTAL

I. MAIL ORDER PRESCRIPTIONS

A. Prescriptions Filled (Total Drug Cost)

B. TED Vouchers (Total of Drug Costs on TEDs submitted to TMA):

Other Transactions:
1.(List any other types of transactions)

TOTAL OF B

II. DRUG REPLENISHMENTS FROM DLA

A. Replenishments Requested (by contractor)

B. Replenishments Received (by contractor)

Instructions:
Complete this report for each month of claim processing. The Year to Date Totals should be based on the Federal fiscal year of October 1st through September 30th.

PREVIOUS MONTH'S YEAR TO DATE TOTAL should match the REPORTING MONTH'S YEAR TO DATE TOTAL from the previous month. Reports for the month of October ,or for the first month of the contract, will have $0 in the PREVIOUS MONTH'S YEAR TO DATE TOTAL.

THIS MONTH'S TRANSACTIONS should be the totals for the reporting month.
REPORTING MONTH'S YEAR TO DATE TOTAL should be the PREVIOUS MONTH'S YEAR TO DATE TOTAL plus the THIS MONTH'S TRANSACTIONS and equal the totals for the current fiscal year's transactions through the reporting month.
I. A.Prescriptions Filled should be the net total dollar value of the drugs used to fill the prescriptions.
I. B.TED Vouchers totals should be the net total dollar value of the TEDs submitted to TMA including any adjustments and cancelations.
Other Transactions should be any corrections or other manual transactions that were not done as a TED but affects the total dollar value of the drugs used. List the types of transactions these are and the dollar value for each type..

II.A. Replenishments Requested (by the contractor) should be the net total dollar amount of the drugs requested from the Prime Vendor during a month.

II.B. Replenishments Received (by the contractor) should be the net total dollar amount of the drugs received from the Prime Vendor during a month.

File details come from the government source that posted it. Updated .