Secondary Street Address Report the street address of the PC 54 Physician 6/24/10 Text Address 2 Provider of the Prescribing Physician that may contain All 2% C Street Prescribing office number, suite number of PO Box. Address 2 Physician City name of the Address City PC 55 6/24/10 Text Prescribing Report the Prescribing Physician City. All 10% C Physician Provider Physician City External Address State Code State of the Report the of the prescribing PC 56 11/8/12 External Code char[2] All 10% C Physician Source Physician physician here. Source 2 - States State 2 - Text External Address Zip Report the 5 or 9 digit Zip Code as Zip code of the Code External Code defined by the United States Postal PC 57 11/8/12 varchar[9] Prescribing All 10% C Physician Source Source 2 - Zip Service. When submitting the 9-digit Zip Physician Zip 2 - Text Codes Code do not include hyphen. Report the submitter-assigned identifier as it appears in PR001 in the Product Product ID Product File. This element is used to understand PC 58 11/8/12 Text ID Link to PR001 All 100% A0 Number Identification Product and Eligibility attributes of the member / subscriber as applied to this record. Lookup Report the value that defines the element. Mail Order Indicator - Mail PC 59 11/8/12 Table - tlkpFlagIndicators int[1] EXAMPLE: 1 = Yes, pharmacy is a mail All 100% A2 pharmacy Order Option Integer order pharmacy Value Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable Script Prescription Report the unique identifier of the PC 60 6/24/10 Text ID Claim Number All 100% B number Number prescription. Report the member's PCP ID here. The Recipient Patient's PCP value in this element must have a PC 61 6/24/10 Text ID Link to PV002 All 98% B PCP ID ID Number corresponding Provider ID (PV002) in the Provider File.
PC 54 Physician Street Address 2 6/24/10 Text Address 2 Provider Secondary Street Address of the Prescribing Physician Report the street address of the Prescribing Physician that may contain office number, suite number of PO Box. All 2% C PC 55 Physician City 6/24/10 Text Address City Provider City name of the Prescribing Physician Report the Prescribing Physician City. All 10% C PC 56 Physician State 11/8/12 External Code Source 2 - Text Address State External Code Source 2 - States char[2] State of the Physician Report the of the prescribing physician here. All 10% C PC 57 Physician Zip 11/8/12 External Code Source 2 - Text Address Zip External Code Source 2 - Zip Codes varchar[9] Zip code of the Prescribing Physician Report the 5 or 9 digit Zip Code as defined by the United States Postal Service. When submitting the 9-digit Zip Code do not include hyphen. All 10% C PC 58 Product ID Number 11/8/12 Text ID Link to PR001 Product Identification Report the submitter-assigned identifier as it appears in PR001 in the Product File. This element is used to understand Product and Eligibility attributes of the member / subscriber as applied to this record. All 100% A0 PC 59 Mail Order pharmacy 11/8/12 Lookup Table - Integer tlkpFlagIndicators int[1] Indicator - Mail Order Option Report the value that defines the element. EXAMPLE: 1 = Yes, pharmacy is a mail order pharmacy All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable PC 60 Script number 6/24/10 Text ID Claim Number Prescription Number Report the unique identifier of the prescription. All 100% B PC 61 Recipient PCP ID 6/24/10 Text ID Link to PV002 Patient's PCP ID Number Report the member's PCP ID here. The value in this element must have a corresponding Provider ID (PV002) in the Provider File. All 98% B