Report the prescriber's plan number here. PC 51 Physician 11/8/12 Text ID Plan Do not report any here if not All 10% C Plan Provider Plan ID contracted with the carrier. Number Report the license number for the provider identified in PC043. For a doctor this is the medical license for a Prescribing this is the practice license. Do not PC 52 Physician 11/8/12 Text ID License Physician All 10% B use zero-fill. If not available, or not License License Number applicable, such as for a group or Number corporate entity, do not report any value here. Street address of the Report the street address of the PC 53 Physician 6/24/10 Text Address 1 Provider All 10% C Prescribing Prescribing Physician Street Physician Address 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 state 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 Report the 5 or 9 digit Zip Code as Address Zip Zip code of the Code defined by the United States Postal PC 57 11/8/12 External Code varchar[9] Prescribing All 10% C Physician Source Service. When submitting the 9-digit Zip Source 2 - Zip Physician Zip 2 - Text Code do not include hyphen.
PC 51 Physician Plan Number 11/8/12 Text ID Plan Provider Plan ID Report the prescriber's plan number here. Do not report any here if not contracted with the carrier. All 10% C PC 52 Physician License Number 11/8/12 Text ID License Prescribing Physician License Number Report the license number for the provider identified in PC043. For a doctor this is the medical license for a this is the practice license. Do not use zero-fill. If not available, or not applicable, such as for a group or corporate entity, do not report any value here. All 10% B PC 53 Physician Street Address 6/24/10 Text Address 1 Provider Street address of the Prescribing Physician Report the street address of the Prescribing Physician All 10% C 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 state 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 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
v5-apcd-pharmacy-claim-file-submission-guide-FINAL.docx