State of Wisconsin

Administrative Services as the State of Wisconsin Pharmacy Benefits Manager

RFP # ETJ0007

2009 Calendar Year Pharmacy Claims - Dictionary

File Layout:

The Claims File Extract is produced in text file format and is semicolon delimited.

Following is the file layout:

Field Name / Max Field Length / Description
Provider ID / 15 / Submitted service Provider ID
Provider Name / 25 / Service Provider (Pharmacy) Name
Provider Zip / 10 / Pharmacy Zip
NDC Code / 20 / NDC code
Metric Strength / 9 / Drug Metric Strength
Dosage Form / 4 / Drug Dosage Form
Decimal Qty / 9 / Quantity Dispensed
Days Supply / 9 / Days Supply
R/M Indicator / 6 / Retail or Mail Order indicator
Script Count / 9 / Script counter

Total Data Rows 856,371

Sum of Script Count 4,060,858

Drug Dosage Form:

Dosage Form / Description / Dosage Form / Description
AEPB / Aerosol powder / CP12 / Capsules - 12 hour dosing
AERB / Aerosol breath / CP24 / Capsules - 24 hour dosing
AERO / Aerosol / CPCR / Capsules - controlled release
AERS / Aerosol solution / CPDR / Capsules - delayed release
CAPS / Capsules / CPEP / Capsules - enteric coated
CHEW / Chewables / CREA / Cream
Continued on the next page
Dosage Form / Description / Dosage Form / Description
DEVI / Device / PTTW / Patch biweekly
ELIX / Elixir / PTWK / Patch weekly
EMUL / Emulsion / RING / ring
FOAM / Foam / SHAM / Shampoo
GEL / Gel (jelly) / SOLG / Gel form solution
INHA / Inhaler / SOLN / Solution
INJ / Injection / SOLR / Solution reconstituted
KIT / Kit / STRP / Strip
LIQD / Liquid / SUBL / Sublingual
LOTN / Lotion / SUPP / Suppository
LQCR / Liquid - controlled release / SUSP / Suspension
MISC / Miscellaneous / SUSR / Supspension reconstituted
NEBU / Nebulization solution / SWAB / Swab
OIL / Oil / SYRP / Syrup
OINT / Ointment / TABS / Tablets
PACK / Pack / TB12 / Tablet - 12 hour dosing
PADS / Pads / TB24 / Tablet - 24 hour dosing
POWD / Powder / TBCR / Tablet - controlled release
PSTE / Paste / TBDP / Tablet - dispersible
PT24 / Patch - 24 hour dosing / TBEC / Tablet - enteric coated
PT72 / Patch - 72 hour dosing / TBEF / Tablet - effervescence
PTCH / Patch / TROC / Troche - dissolve by mouth

Page 1 of 2