CMS Record Specification

MEDICAID DRUG REBATE

Rebate File Record Format

May 1, 2011

Source: CMS

Target: State Agencies

Field

Size

Position

Remarks

Record ID

4

1 - 4

Constant of “01@@”

Labeler Code

5

5 - 9

NDC #1

Product Code

4

10 - 13

NDC #2

Package Size Code

2

14 - 15

NDC #3

Period Covered

5

16 - 20

QYYYY

Product Name

10

21 - 30

See Data Element Definitions

Drug Category

1

31 - 31

See Data Element Definitions

DESI Indicator

1

32 - 32

See Data Element Definitions

TEC

2

33 - 34

See Data Element Definitions

Unit Type

3

35 - 37

See Data Element Definitions

Units Per Pkg Size

10

38 - 47

9999999V999

Rebate Amt. Per Unit

11

48 - 58

99999V999999

FDA Approval Date

8

59 - 66

MMDDYYYY

Date Entered Market

8

67 - 74

MMDDYYYY

Termination Date

8

75 - 82

MMDDYYYY

Drug Type Indicator

1

83 - 83

See Data Element Definitions

Clotting Factor Indicator

1

84 - 84

Y or N

Pediatric Indicator

1

85 – 85

Y or N

Record Type Indicator

1

86 – 86

See Data Element Definitions

Chenepalli, Ramya

2014-12-22

Srikanth Gadiyaram

Microsoft