MEDICAID DRUG REBATE PROGRAM
ELECTRONIC STATE INVOICE
Form CMS-R-144
RECORD FORMAT
Effective: July 1, 2021
Source: State Agencies
Target: CMS & Manufacturers
Ordinal Positon |
Field (.TXT) Header Row (.CSV) |
Size |
Position |
Remarks |
1 |
Record ID |
4 |
1 - 4 |
Constant of “FFSU” or “MCOU” |
2 |
State Code |
2 |
5 - 6 |
P.O. Abbreviation |
3 |
Labeler Code |
5 |
7 - 11 |
NDC 1 |
4 |
Product Code |
4 |
12 -15 |
NDC 2 |
5 |
Package Size |
2 |
16 - 17 |
NDC 3 |
6 |
Period Covered |
5 |
18 - 22 |
QYYYY |
7 |
FDA Product Name |
10 |
23 - 32 |
Product name as appears on FDA listing form. (1st 10 characters) |
8 |
Unit Rebate Amount |
15 |
33 - 47 |
99999999.999999 |
9 |
Units Reimbursed |
16 |
48 - 63 |
999999999999.999 |
10 |
Rebate Amount Claimed |
16 |
64 - 79 |
9999999999999.99 |
11 |
Number of Prescriptions |
8 |
80 - 87 |
99999999 |
12 |
Medicaid Amount Reimbursed |
16 |
88 - 103 |
9999999999999.99 |
13 |
Non-Medicaid Amount Reimbursed |
16 |
104 - 119 |
9999999999999.99 |
14 |
Total Amount Reimbursed |
16 |
120 - 135 |
9999999999999.99 |
15 |
Filler - State Invoice Delete Flag - SDUD Submission to CMS |
1 |
136 - 136 |
See Data Definitions |
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | MEDICAID DRUG REBATE PROGRAM |
| Author | CMS |
| File Modified | 0000-00-00 |
| File Created | 2021-03-02 |