Name	Value
RECORD FORMAT NAME	PHIDRXB1
VERSION	Version 5.1
PRODUCTION STATUS	PRODUCTION
PAYER SHEET VERSION	1
TRANSACTION HEADER SEGMENT	TRANSACTION HEADER ORDER: 10 NCPDP FIELD NUMBER: 102 PROCESSING MODE: STANDARD TRANSACTION HEADER ORDER: 12 NCPDP FIELD NUMBER: 103 PROCESSING MODE: STANDARD TRANSACTION HEADER ORDER: 13 NCPDP FIELD NUMBER: 104 PROCESSING MODE: STANDARD TRANSACTION HEADER ORDER: 15 NCPDP FIELD NUMBER: 109 PROCESSING MODE: STANDARD TRANSACTION HEADER ORDER: 17 NCPDP FIELD NUMBER: 202 PROCESSING MODE: STANDARD TRANSACTION HEADER ORDER: 19 NCPDP FIELD NUMBER: 201 PROCESSING MODE: STANDARD TRANSACTION HEADER ORDER: 21 NCPDP FIELD NUMBER: 401 PROCESSING MODE: STANDARD TRANSACTION HEADER ORDER: 22 NCPDP FIELD NUMBER: 110 PROCESSING MODE: STANDARD TRANSACTION HEADER ORDER: 9 NCPDP FIELD NUMBER: 101 PROCESSING MODE: STANDARD
PATIENT SEGMENT	PATIENT SEGMENT ORDER: 31 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 33 NCPDP FIELD NUMBER: 331 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 35 NCPDP FIELD NUMBER: 332 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 36 NCPDP FIELD NUMBER: 304 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 37 NCPDP FIELD NUMBER: 305 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 39 NCPDP FIELD NUMBER: 310 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 41 NCPDP FIELD NUMBER: 311 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 43 NCPDP FIELD NUMBER: 322 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 45 NCPDP FIELD NUMBER: 323 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 47 NCPDP FIELD NUMBER: 324 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 50 NCPDP FIELD NUMBER: 325 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 52 NCPDP FIELD NUMBER: 326 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 54 NCPDP FIELD NUMBER: 307 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 55 NCPDP FIELD NUMBER: 333 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 56 NCPDP FIELD NUMBER: 334 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 58 NCPDP FIELD NUMBER: 335 PROCESSING MODE: STANDARD
INSURANCE SEGMENT	INSURANCE SEGMENT ORDER: 67 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 69 NCPDP FIELD NUMBER: 302 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 71 NCPDP FIELD NUMBER: 312 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 73 NCPDP FIELD NUMBER: 313 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 75 NCPDP FIELD NUMBER: 314 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 76 NCPDP FIELD NUMBER: 524 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 77 NCPDP FIELD NUMBER: 309 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 80 NCPDP FIELD NUMBER: 336 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 81 NCPDP FIELD NUMBER: 301 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 82 NCPDP FIELD NUMBER: 303 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 83 NCPDP FIELD NUMBER: 306 PROCESSING MODE: STANDARD
CLAIM SEGMENT	CLAIM SEGMENT ORDER: 100 NCPDP FIELD NUMBER: 436 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 102 NCPDP FIELD NUMBER: 407 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 104 NCPDP FIELD NUMBER: 456 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 107 NCPDP FIELD NUMBER: 457 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 110 NCPDP FIELD NUMBER: 442 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 112 NCPDP FIELD NUMBER: 403 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 113 NCPDP FIELD NUMBER: 405 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 114 NCPDP FIELD NUMBER: 406 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 115 NCPDP FIELD NUMBER: 408 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 117 NCPDP FIELD NUMBER: 414 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 120 NCPDP FIELD NUMBER: 415 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 123 NCPDP FIELD NUMBER: 308 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 125 NCPDP FIELD NUMBER: 343 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 128 NCPDP FIELD NUMBER: 344 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 131 NCPDP FIELD NUMBER: 345 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 93 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 95 NCPDP FIELD NUMBER: 455 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 98 NCPDP FIELD NUMBER: 402 PROCESSING MODE: STANDARD
PRESCRIBER SEGMENT	PRESCRIBER SEGMENT ORDER: 141 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 143 NCPDP FIELD NUMBER: 466 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 145 NCPDP FIELD NUMBER: 411 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 146 NCPDP FIELD NUMBER: 467 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 148 NCPDP FIELD NUMBER: 427 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 150 NCPDP FIELD NUMBER: 498 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 152 NCPDP FIELD NUMBER: 468 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 155 NCPDP FIELD NUMBER: 421 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 157 NCPDP FIELD NUMBER: 469 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 160 NCPDP FIELD NUMBER: 470 PROCESSING MODE: STANDARD
DUR PPS SEGMENT	DUR PPS SEGMENT ORDER: 170 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 172 NCPDP FIELD NUMBER: 473 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 174 NCPDP FIELD NUMBER: 439 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 176 NCPDP FIELD NUMBER: 440 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 178 NCPDP FIELD NUMBER: 441 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 180 NCPDP FIELD NUMBER: 474 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 182 NCPDP FIELD NUMBER: 475 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 184 NCPDP FIELD NUMBER: 476 PROCESSING MODE: STANDARD
PRICING SEGMENT	PRICING SEGMENT ORDER: 192 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 194 NCPDP FIELD NUMBER: 409 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 196 NCPDP FIELD NUMBER: 412 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 198 NCPDP FIELD NUMBER: 433 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 201 NCPDP FIELD NUMBER: 426 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 204 NCPDP FIELD NUMBER: 430 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 205 NCPDP FIELD NUMBER: 423 PROCESSING MODE: STANDARD
COMPOUND SEGMENT	COMPOUND SEGMENT ORDER: 214 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 216 NCPDP FIELD NUMBER: 450 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 219 NCPDP FIELD NUMBER: 451 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 221 NCPDP FIELD NUMBER: 452 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 223 NCPDP FIELD NUMBER: 447 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 225 NCPDP FIELD NUMBER: 488 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 227 NCPDP FIELD NUMBER: 489 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 228 NCPDP FIELD NUMBER: 448 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 230 NCPDP FIELD NUMBER: 449 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 232 NCPDP FIELD NUMBER: 490 PROCESSING MODE: STANDARD
CLINICAL SEGMENT	CLINICAL SEGMENT ORDER: 242 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 244 NCPDP FIELD NUMBER: 491 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 246 NCPDP FIELD NUMBER: 492 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 248 NCPDP FIELD NUMBER: 424 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 249 NCPDP FIELD NUMBER: 493 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 252 NCPDP FIELD NUMBER: 494 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 253 NCPDP FIELD NUMBER: 495 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 254 NCPDP FIELD NUMBER: 496 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 256 NCPDP FIELD NUMBER: 497 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 257 NCPDP FIELD NUMBER: 499 PROCESSING MODE: STANDARD

PHIDRXB1 (276) BPS NCPDP FORMATS (9002313.92)