CMS Pub. 100-04, ch. 23, § 100.4

Field Name Pic Position Comment

Supplier NSC

Number

X(10) 1 - 10

Supplier NPI Number X(10) 11 - 20

Field Name Pic Position Comment

CBA Area X(5) 21 - 25 16740 = Charlotte NC-SC

16741 = Charlotte NC-SC Mail Order

17140 = Cincinnati OH

17141 = Cincinnati OH Mail Order

17460 = Cleveland OH

17461 = Cleveland OH Mail Order

19100 = Dallas TX

19101 = Dallas TX Mail Order

28140 = Kansas MO-KS

28141 = Kansas MO- KS Mail Order

33100 = Miami FL

33101 = Miami FL Mail Order

36740 = Orlando FL

36741 = Orlando FL Mail Order

38300 = Pittsburgh PA

38301 = Pittsburgh PA Mail Order

40140 = Riverside CA

40141 = Riverside CA Mail Order

Bid Effective Date X(8) 26 - 33

Bid Effective Date-

CC

9(2) 26 - 27

Bid Effective Date-Year

9(2) 28 - 29

Bid Effective Date -

Month

9(2) 30 - 31

Bid Effective Date-

Day

9(2) 32 - 33

Bid Expiration Date X(8) 34 - 41

Bid Expiration Date -

CC

9(2) 34 - 35

Field Name Pic Position Comment

Bid Expiration Date -

Year

9(2) 36 - 37

Bid Expiration Date-

Month

9(2) 38 - 39

Bid Expiration Date -

Day

9(2) 40 - 41

Bid Switches Occurs

500 Times

X(500) 42-541 The switch occurrence equates to the

500 Times Bid category; i.e., Bid

Switch (1) denotes the supplier contract

for category 001

Bid Switch (1) X(1) 42 - 42

Bid Switch (2) X(1) 43 - 43

Filler X(59) 542 - 600