Product transfer account adjustment request (X12)

Tracelink University

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A Product Transfer Account Adjustment Request is a formal transaction used to resolve pricing or financial discrepancies when products move between trading partners—typically from a manufacturer to a distributor or wholesaler. It is most often used in chargeback scenarios, where the distributor requests reimbursement for selling a product at a contract price that is lower than the price they originally paid.

A Product Transfer Account Adjustment Request is a formal transaction used in the pharmaceutical supply chain to correct financial discrepancies related to the movement of products between trading partners—typically between wholesalers/distributors and manufacturers. It is most commonly associated with chargeback claims, where a distributor seeks reimbursement for selling a product at a contracted price that is lower than their acquisition cost.

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Message Type: MPC_PRODUCT_TRANSFER_ACCOUNT_ADJUSTMENT_REQUEST
X12 Format: X12 844
Transform Names:
- B2B_EDI_X12_844_ProductTransferAccountAdjustmentRequest_IB_V2
- B2B_EDI_X12_844_ProductTransferAccountAdjustmentRequest_OB_V2

Guidelines

Input Element						Occurs	Length	Description	Examples
ISA						1…1	-	Required. ISA interchange envelope.	-
	ISA01					1…1	2/2	Required. Authorization information qualifier identifying the type of identifier in ISA02. Valid values: `00` - No authorization information in ISA02 `01` - UCS communications `02` - EDX `03` - Additional identifier `04` - Rail communication identifier `05` - Dept of Defense (DOD) identifier `06` - US Federal Government identifier `07` - Truck communications identifier `08` - Ocean communications identifier Typically this value is `00`.	00
	ISA02					1…1	10/10	Required. Authorization identifier value used for additional identification or authorization of the interchange sender or the data in the interchange. If ISA01 = `00`, this will be populated by a ten spaces If ISA01 ≠ `00`, ISA02 must be populated with an identifier padded to 10 characters, if less than 10 characters.	-
	ISA03					1…1	2/2	Required. Qualifier for security information in ISA04. Valid values: `00` - No security information present `01` - Password Typically this value is `00`	00
	ISA04					1…1	10/10	Required. Security information identifying for the interchange sender or data. If ISA03 = `00`, this will be populated by ten spaces. If ISA03 ≠ `00`, ISA04 must be populated with a password that is padded to 10 characters, if less than 10 characters.	-
	ISA05					1…1	2/2	Required. Interchange sender partner ID qualifier. All X12 sender identifier type qualifiers in ISA05 are supported.	07
	ISA06					1…1	15/15	Required. ISA interchange sender identifier.	7777776067344
	ISA07					1…1	2/2	Required. Interchange receiver partner ID qualifier. All X12 receiver identifier type qualifiers in ISA07 are supported.	01
	ISA08					1…1	15/15	Required. ISA interchange receiver ID.	888888404358877
	ISA09					1…1	6/6	Required. Interchange date in 6 char date format YYMMDD	231020
	ISA10					1…1	4/4	Required. Interchange time in 4 char time format HHMM	1420
	ISA11					1…1	1/1	Required. The value of this element is dependent on X12 version. `004012`: Interchange control standards identifier. Valid value is `U`. `004020` and later: Repetition separator, a delimiter that separates repeated occurrences of a data element or composite data structure, which must be different from the data element separator, component separator, and segment terminator.	^
	ISA12					1…1	5/5	Required. Interchange control version number. This could be any X12 version beginning with `004012` and later. Version `004010` and earlier are not supported by this instance of the 853.	00501
	ISA13					1…1	9/9	Required. ISA interchange control number.	0000000000619827
	ISA14					1…1	1/1	Required. Interchange level acknowledgment requested. Valid values: `0` - No acknowledgment requested `1` - Interchange level acknowledgment requested	0
	ISA15					1…1	1/1	Required. Indicates whether the interchange is for production, test, or information purposes. Valid values: `I` - Information `P` - Production data `T` - Test data	P
	ISA16					1…1	1/1	Required. Component element separator. Delimiter that separates data elements within a composite data structure. Must be different than the data element separator and segment terminator.	>
GS						1…*	-	Required. GS group functional envelope. Child of ISA. Only one GS group expected per interchange.	-
	GS01					1…1	2/2	Required. GS group function code. Valid value is `RI` - Routing and Carrier Instruction message X12 853.	CF
	GS02					1…1	2/15	Required. Application sender's code in the group envelope.	2222224043588
	GS03					1…1	2/15	Required. Application receiver's code in the group envelope.	TRACELINK
	GS04					1…1	8/8	Required. Group envelope date value in date format YYYYMMDD.	20241020
	GS05					1…1	4/8	Required. Group envelope time value in time format HHMM or HHMMSS.	142000
	GS06					1…1	1/9	Required. Group control identifier.	619827
	GS07					1…1	1/2	Required. Responsible Agency Code. Valid values: `T` - Transportation Data Coordinating Committee (TDCC) `X` - X12 Accredited Standards Committee	X
	GS08					1…1	1/12	Required. X12 message version code. This could be any X12 version beginning with `004012`. Version `004010` and earlier are not supported by this instance of the 853.	005010
ST						1…*	-	Required. ST transaction set envelope. Child of GS group. Only one ST transaction expected.	-
	ST01					1…1	3/3	Required. Transaction set identifier code.	844
	ST02					1…1	4/9	Required. Transaction set ID number. Counter for each ST segment beginning with 1.	0001
	BAA					1…1	-	Required. Product Transfer Account Request beginning segment. Note: there is no transaction identifier in BPA.	-
		BAA01				1…1	2/2	Required. Transaction set purpose code. Valid values: `00` - ORIGINAL `15` - RESEND `18` - REISSUE `41` - CORRECTEDVERIFIED `05` - REPLACE `45` - FOLLOWUP	00
		BAA02				1…1	2/2	Required. Adjustment transaction type code. Valid values: `CR` - Credit Memo `DR` - Debit Memo `RA` - Credit Request `DU` - Duplicate `RC` - Price Quote Request	CR
		BAA03				1…1	8/8	Required. Account Adjustment Date.	20240919
		BAA04				0…1	2/3	Reference identification qualifier for contract number.	AM
		BAA05				0…1	'1/80	Reference identification number for contract number	1234C
	REF					0…12	-	REF reference segment for mapping to handle resubmission.	-
		REF01				1…1	2/3	Required. Reference identification qualifier for resubmission of adjustment request. Valid value is `RX` - Resubmit Number	RX
		REF02				0…1	1/80	Reference identifier value: Contract class identifier.	S340B
		REF03				0…1	1/80	Description defined by qualifier code in REF02.	sub-340B
	CUR					0…1	-	Currency code info for payment record in Product Transfer Account Request/status.	-
		CUR01				1…1	2/3	Required. Entity identifier code for an organization, physical location, property or individual for use of the currency. Valid value: `SE` - Selling party currency `BY` - Buying party (Purchaser) currency	SE
		CUR02				1…1	3/3	Required. Standard ISO currency code for the country in which the payments are specified.	USD
		CUR03				0…1	4/10	Exchange rate value to be used as a multiplier conversion factor to convert monetary value from one currency to another.	-
	N1					0…1	-	Required. Instance 1 of the N1 name segment loop for the Purchasing group(customer or buyer) party information extended with dates and reference identifiers.	-
		N101				1…1	2/3	Required. Entity qualifier for the Customer or Buyer party identifier and address information. Valid values: `BG` - Purchasing Group party `BY` - Customer party `SU` - Supplier party `MF` - manufacturer party `DS` - Distributor party `DB` - Distributor branch	BG
		N102				0…1	1/60	Name.	Pharma customer
		N103				0…1	1/2	Required. Identifier code qualifier. Valid values: `1` - DUNS `9` - DUNS+4 `11` - Drug Enforcement Agency registration number `21` - Health Industry Number `91` - Company identifier `92` - Company location identifier `UL` - Global Location Number	UL
		N104				0…1	2/80	Required. Buyer party identifier as qualified by N103 mapping to companyIdentifierValue.	3333331013655
		N3				0…1	-	N3: Address: Child of purchasing group (buyer party) N1 name segment.	-
			N301			1…1	1/55	Required. Street address 1.	555 Neelan Road
			N302			0…1	1/55	Street address 2.	Suite 123
		N4				0…1	-	N4: Geographic Location. Child of purchasing party N1 name segment.	-
			N401			0…1	2/30	City name.	Sacramento
			N402			0…1	2/2	State or province code. Code (Standard state/province) as defined by appropriate government agency.	CA
			N403			0…1	3/15	Postal code. Code defining international postal zone code excluding punctuation and blanks.	95833
			N404			0…1	2/3	Country code.	US
		PER				0…3	-	Contact Information.	-
			PER01			1…1	2/2	Required. Contact function code identifying major duty or responsibility of person or group named as contact. Valid value is `AJ` = Primary contact	AJ
			PER02			0…1	1/80	Name of the contact person responsible for authenticating the pedigree information.	John Smith
			PER03			0…1	2/2	Communication Number Qualifier identifying the contact person's telephone number or email address. Valid values: `TE` - Telephone number `EM` - email address	TE
			PER04			0…1	1/2048	Communication number: Telephone number of the contact person expected in this field. Email address of the contact person.	+1.516.747.6849
			PER05			0…1	2/2	Communication Number Qualifier identifying the contact person's telephone number or email address. Valid value: `TE` - Telephone number `EM` - email address	EM
			PER06			0…1	1/2048	Communication number: Email address for the contact person expected in this field. Telephone number of the contact person.	jsmith@manufac.com
		REF				0…*	-	REF reference segment for mapping to the electronic payment identifier.	-
			REF01			1…1	2/3	Required. Transaction reference type for X12 segments REF and N9 and EDIFACT RFF for general reference data that is not a transaction document identifier. HDA mapping for Product Transfer Account Request in N1 party loop for buying group only. Valid value is `CT`	-
			REF02			0…1	1/80	Transaction reference identifier value as defined by enum in transactionReferenceType. HDA: Contract header type code defining identifier/description in description attribute (REF03).	-
	CON Loop					1…*	-	Required. Contract Number details loop for specifying contract reference number and status.	-
		CON01				1…1	2/3	Required. Reference identification qualifier Transaction reference type for X12 segments REF and N9 and EDIFACT RFF for general reference data that is not a transaction document identifier. HDA mapping. Valid value is `VC` - Vendor/Supplier contract number	VC
		CON02				1…1	1/80	Required. Reference identification id, Reference information as defined for a particular transaction set or as specified by the Reference Identification Qualifier vendor or supplier contract id.	12312LS
		CON03				1…1	2/2	Required. Contract current status code valid values: `OC` - Original contract `VA` - Valid open contract	VA
		REF				0…12	-	REF reference segment loop for contract number reference in CON loop group.	-
			REF01			1…1	2/3	Required. Reference identification qualifier for resubmission of adjustment request. Valid value is `L1` - Letters or notes	L1
			REF02			0…1	1/80	Reference identifier value: Contract class identifier.	S340B
			REF03			0…1	1/80	Description defined by qualifier code in REF02.	sub-340B
		DTM				0…10	-	DTM date segment for contract reference dates in CON loop.	-
			DTM01			1…1	3/3	Required. Date type qualifier for the contract reference dates in CON loop.	-
			DTM02			0…1	8/8	Processing date in date format YYYYMMDD.	-
			DTM03			0…1	4/8	Processing time in time format HHMMSS.	-
		N1				0…1	-	Required. The CON-N1 name segment loop for the customer party information extended with sales item and reference identifiers. HDA usage note: This N1 loop at the Detail Level in the CON loop is required to identify eligible customers belonging to sales item information for which account adjustment to be made.	-
			N101			1…1	2/3	Required. Entity qualifier for the Customer or Buyer party identifier and address information. Valid values: `BY` - Buyer party `ST` - Ship to party `EC` - Intermediate contract party `BG` - Purchasing Group party	BY
			N102			0…1	1/60	Name.	Pharma customer
			N103			0…1	1/2	Required. Identifier code qualifier. Valid values: `1` - DUNS `9` - DUNS+4 `11` - Drug Enforcement Agency registration number `21` - Health Industry Number `91` - Company identifier `92` - Company location identifier `UL` - Global Location Number	93
			N104			0…1	2/80	Required. Buyer party identifier as qualified by N103 mapping to companyIdentifierValue.	3333331013655
			N3			0…1	-	N3: Address: Child of customer party N1 name segment.	-
				N301		1…1	1/55	Required. Street ad.dress 1.	555 Neelan Road
				N302		0…1	1/55	Street address 2.	Suite 123
			N4			0…1	-	N4: Geographic Location. Child of customer party N1 name segment.	-
				N401		0…1	2/30	City name.	Sacramento
				N402		0…1	2/2	State or province code. Code (Standard state/province) as defined by appropriate government agency.	CA
				N403		0…1	3/15	Postal code. Code defining international postal zone code excluding punctuation and blanks.	95833
				N404		0…1	2/3	Country code.	US
			REF			0…12	-	Instance 2 of the REF reference segment for mapping to other reference identifiers	-
				REF01		1…1	2/3	Required. Reference information for identifiers that are not related to transaction documents. HDA mapping. Valid values: `2U` - Payer Identification Number used for covered entity `DH` - Drug Enforcement Administration Number `HI` - Health Industry Number (HIN) `L1` - Letters or Notes `LU` - GS1-US Global Location Number (GLN) `X8` - SECONDARYTRADECLASS `ACD` - PRIMARYCLASS `P7` - Product Line Number `PO` - Purchase Order	1W
				REF02		0…1	1/80	Transaction reference identifier value as defined by enum in transactionReferenceType.	AC
				REF03		0…1	1/80	A free-form description to clarify the related data elements and their content. HDA: Identifier or description defined by qualifier code in transactionReferenceIdentifier (REF02).	Acute Care
				SII		0…*	-	Required. SII segment in CON-N1-SII loop. To specify line item information related to a sale of an item for account adjustment request.	-
					SII01	1…1	2/2	Required. Product code qualifier for sales item in CON-N1-SII loop. Valid values: `BP` - CUSTOMER `VN` - SUPPLIER `UK` - GTIN14 `UP` - UPC `UX` - UPN (universal product number) `MF` - MANUFACTURER `N1` - US_NDC442 `N2` - US_NDC532 `N3` - US_NDC541 `N4` - US_NDC542 `N5` - US_NHRIC55 `N6` - US_NHRIC64 `NH` - US_NHRIC) - Elizabeth `ND` - National Drug Code	ND
					SII02	1…1	1/90	Required. Identifying number for a product or service.	123422
					SII03	1…1	1/15	Required. Total quantity of sold item included into account adjustment request.	10
					SII04-01	1…1	2/2	Required. Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken. .Valid values `02` – Statute Mile `4G` – Microliter `AM` – Ampoule `AV` – Capsule `BD` – Bundle `BG` – Bag `BO` – Bottle `BX` – Box `C3` – Centiliter `CA` – Case `CC` – Cubic Centimeter `CF` – Cubic Feet `CG` – Card, Blister `CI` – Cubic Inches `CL` – Cylinder `CM` – Centimeter `CN` – Can `CP` – Crate `CQ` – Cartridge `CR` – Cubic Meters `CT` – Carton `DA` – Day `DI` – Dispenser `DK` – Kilometers `DL` – Deciliter `DM` – Decimeter `DR` – Drum `DS` – Display `DZ` – Dozen `EA` – Each `FO` – Fluid Ounce `FT` – Foot `GA` – Gallon `GL` – Gram/liter `GR` – Gram `GS` – Gross `H4` – Hectoliter `HF` – Hundred Feet `HR` – Hours `IN` – Inch `K6` – Kiloliters `KG` – Kilogram `KT` – Kit `LB` – Pounds `LF` – Linear Foot `LO` – Lot (unit of procurement) `LT` – Liter `LY` – Linear Yard `MC` – Microgram `ME` – Milligram `ML` – Milliliter `MM` – Millimeter `MO` – Months `MR` – Meter `OZ` – Ounces `PC` – Piece `PF` – Pallet `PK` – Package `PR` – Pair `PT` – Pint `QT` – Quart `RL` – Roll `SC` – Square Centimeter `SF` – Square Foot `SH` – Sheet `SI` – Square Inch `SM` – Square Meter `ST` – Set `SY` – Square Yard `T3` – Thousand Pieces `TB` – Tube `TH` – Thousand `TY` – Tray `U2` – Tablet `UM` – Million `UN` – Unit `V2` – Pouch `VI` – Vial `WK` – Week `YD` – Yard `YR` – Years	EA
					SII05	0…1	1/17	Required. Wholesale unit price type code.	5.98
					SII06	0…1	1/17	Required. contract unit price type code.	6.98
					SII07	0…1	1/18	Required. Monetary amount.	20.76
				N9		0…1	-	Required. Reference information for identifiers that are related to transaction documents. This group would map to X12 segments N9 for information may be related to transaction documents.	-
					N901	1…1	2/3	Required. Transaction reference qualifier for contract account adjustment request CON-N1-SII loop. Valid value is `DI` - Distributor Invoice	DI
					N902	0…1	1/80	Required. Transaction reference identifier value as defined by enum in transactionReferenceType. Pass thru X12 mapping.	4567892
					N903	0…1	1/45	Identifier or description defined by qualifier code in transactionReferenceIdentifier, widely used for Order date references as per HDA usage guideline.	123422ABCD
					N904	0…1	8/8	Transaction reference date related to product transfer account adjustment request. HDA Usage: This date must be the original date of sale rather than the invoice date because an 844 can be sent to a manufacturer more than once.	20251031
					N905	0…1	4/8	Contract date in date format YYYYMMDD.	-
					N906	0…1	2/2	Contract time code.	-
					N907-01	1…1	2/3	Required. Transaction reference qualifier for contract account adjustment request CON-N1-SII loop. Valid values: `L1` - Letters or Notes `P7` - PRODUCTLINENUMBER `SE` - Serial Number	L1
					N907-02	1…1	1/80	Required. Transaction reference identifier value as defined by enum in transactionReferenceType. Pass thru X12 mapping.	4567892
		PAD				0…*	-	Product adjustment detailed group. Adjustments with reason codes but without reference to an invoice.	-
			PAD01			0…1	1/20	The line item number restarts and resets to 1 for each new loop of the canonicalPriceAuthorizationItemDetails array.	1
			PAD02			0…1	2/2	Product transfer type code, valid mappings are: `SD` - Ship and Debit Sale `SS` - Stock sale `DS` - Ship drop sale `CS` - Contract sale `BR` - Exchange `BN` - Return	SD
			PAD03			0…1	2/2	Change or response type code specifying the type of change recorded in the product adjustment details loop. Valid values: `AI` - Add additional items `CA` - Changes to line items `CT` - Change dates `DI` - Delete items `OA` - Original confirmation of revised announcement `OC` - Original confirmation of original announcement `PC` - Price change `RB` - Replace all dates `RE` - Replacement item	AI
			LIN			0…1	-	Item identification segment in CON-PAD, one segment per PAD.	-
				LIN01		0…1	1/20	Line item identification.	0001
				LIN02		1…1	2/2	Required. Product service ID qualifier mapping from global standards enum list. Valid values: `BP` - CUSTOMER `VN` - SUPPLIER `UK` - GTIN14 `UP` - UPC `UX` - UPN (universal product number) `MF` - MANUFACTURER `N1` - US_NDC442 `N2` - US_NDC532 `N3` - US_NDC541 `N4` - US_NDC542 `N5` - US_NHRIC55 `N6` - US_NHRIC64 `NH` - US_NHRIC) - Elizabeth `ND` - National Drug Code	ND
				LIN03		1…1	1/80	Required. Product or service identifier.	08202000230
			UIT			0…20	-	Item unit data information such as shipping, ordering. CON-PAD-UIT	-
				UIT01		1…1	-	Required. -	-
				UIT01.1		1…1	2/2	Required. Unit of measure for recorded product in adjustment. Valid values: `UN (HDA)` `EA` `CA`	UN
				UIT02		0…1	1/17	Item unit price.	12.10
				UIT03		0…1	2/2	Code identifying the type of unit price. Valid values: `CT` - Contract `WH` - Wholesale	CT
			QTY			0…5	-	To specify quantity information, for CON-PAD loop.	-
				QTY01		1…1	2/2	Required. Quantity type qualifier. Valid value is `39` - Shipped Quantity	39
				QTY02		0…1	1/15	Numeric value of quantity.	10
				QTY03.1		1…1	2/2	Required. To identify a composite unit of measure. .Valid values `02` – Statute Mile `4G` – Microliter `AM` – Ampoule `AV` – Capsule `BD` – Bundle `BG` – Bag `BO` – Bottle `BX` – Box `C3` – Centiliter `CA` – Case `CC` – Cubic Centimeter `CF` – Cubic Feet `CG` – Card, Blister `CI` – Cubic Inches `CL` – Cylinder `CM` – Centimeter `CN` – Can `CP` – Crate `CQ` – Cartridge `CR` – Cubic Meters `CT` – Carton `DA` – Day `DI` – Dispenser `DK` – Kilometers `DL` – Deciliter `DM` – Decimeter `DR` – Drum `DS` – Display `DZ` – Dozen `EA` – Each `FO` – Fluid Ounce `FT` – Foot `GA` – Gallon `GL` – Gram/liter `GR` – Gram `GS` – Gross `H4` – Hectoliter `HF` – Hundred Feet `HR` – Hours `IN` – Inch `K6` – Kiloliters `KG` – Kilogram `KT` – Kit `LB` – Pounds `LF` – Linear Foot `LO` – Lot (unit of procurement) `LT` – Liter `LY` – Linear Yard `MC` – Microgram `ME` – Milligram `ML` – Milliliter `MM` – Millimeter `MO` – Months `MR` – Meter `OZ` – Ounces `PC` – Piece `PF` – Pallet `PK` – Package `PR` – Pair `PT` – Pint `QT` – Quart `RL` – Roll `SC` – Square Centimeter `SF` – Square Foot `SH` – Sheet `SI` – Square Inch `SM` – Square Meter `ST` – Set `SY` – Square Yard `T3` – Thousand Pieces `TB` – Tube `TH` – Thousand `TY` – Tray `U2` – Tablet `UM` – Million `UN` – Unit `V2` – Pouch `VI` – Vial `WK` – Week `YD` – Yard `YR` – Years	EA
			DTM			0…10	-	DTM date segment in CON-PAD loop.	-
				DTM01		1…1	3/3	Required. Date type qualifier for contract dates in CON-PAD-DTM loop. Valid value is `011` - SHIPPED	011
				DTM02		0…1	8/8	Contract date in date format YYYYMMDD.	20240628
				DTM03		0…1	4/8	Contract time in time format HHMMSS.	-
			REF			0…12	-	Instance of the REF reference segment for mapping to other reference identifiers	-
				REF01		1…1	2/3	Required. Reference information for identifiers that are not related to transaction documents. HDA mapping. Valid values: `DI` - Distributor Invoice `PO` - Purchase Order `LI` - Sellers Identifier	DI
				REF02		0…1	1/80	Transaction reference identifier value as defined by enum in transactionReferenceType.	45678
				REF03		0…1	1/80	A free-form description to clarify the related data elements and their content.	-
	AMT					0…5	-	Required. AMT-To indicate the total monetary amount.	-
		AMT01				1…1	1/3	Required. Qualifier to specify the type of amount. Valid values: `CC` - Chargeback claim `CE` - Claim Summary `CH` - Change claim `CQ` - Net claim	CC
		AMT02				1…1	1/18	Required. Monetary amount	20.78
		AMT03				0…1	1/1	Credit or debit boolean. Only populated if identified. HDA optional value. Valid values: `C` - Credit `D` - Debit	C
	CTT					0…1	-	Required. CTT-Transaction Totals.	-
		CTT01				1…1	1/6	Required. Total number of line items in the transaction set.	15
SE						1…1	-	Required. ST … SE transaction set trailer envelope. Child of GS group. Only one ST transaction expected.	-
	SE01					1…1	1/10	Required. Total count of segments in ST … SE transaction set including ST and SE segments.	10
	SE02					1…1	4/9	Required. Transaction set control number.	0001
GE						1…1	-	Required. GS … GE functional group trailer envelope. Child of ISA interchange. Only one GS group expected.	-
	GE01					1…1	1/6	Required. Number of transaction sets in functional group.	5
	GE02					1…1	1/9	Required. Functional group control number.	619827
IEA						1…1	-	Required. ISA … IEA interchange control trailer envelope. Only one interchange expected per transmission.	-
	IEA01					1…1	1/5	Required. Number of functional groups in interchange.	1
	IEA02					1…1	9/9	Required. Interchange control number.	0000000000619827

Examples

ISA*00*          *00*          *07*7777776067344  *01*888888404358877*250311*1724*^*00501*000619827*0*P*:~
GS*CF*2222224043588*TRACELINK*20250311*125622*619827*X*005010~
ST*844*0001~
BAA*00*CR*20250311*AM*1234C~
CUR*SE*USD~
REF*RX*S340B*sub-340B~
N1*BG*BG_BusinessName*1*3333331013655~
N3*BG_Address1*BG_Address2~
N4*BG_City*CA*BG_PostCd*US~
PER*AJ*BG_Name1*TE*BG_Phone*EM*BG_Email~
N1*SU*SU_BusinessName*9*3333331013666~
N3*SU_Address1*SU_Address2~
N4*SU_City*CA*SU_PostCd*US~
PER*AJ*SU_Name1*TE*SU_Phone*EM*SU_Email~
N1*MF*MF_BusinessName™*11*3333331013677~
N3*MF_Address1*MF_Address2~
N4*MF_City*CA*MF_PostCd*US~
PER*AJ*MF_Name1*TE*MF_Phone*EM*MF_Email~
N1*DS*DS_BusinessName*21*3333331013688~
N3*DS_Address1*DS_Address2~
N4*DS_City*CA*DS_PostCd*US~
PER*AJ*DS_Name1*TE*DS_Phone*EM*DS_Email~
N1*DB*DB_BusinessName*91*3333331013699~
N3*DB_Address1*DB_Address2~
N4*DB_City*CA*DB_PostCd*US~
PER*AJ*DB_Name1*TE*DB_Phone*EM*DB_Email~
N1*BY*BY_BusinessName*92*1133331013600~
N3*BY_Address1*BY_Address2~
N4*BY_City*CA*BY_PostCd*US~
PER*AJ*BY_Name1*TE*BY_Phone*EM*BY_Email~
CON*VC*12312LS*VA~
REF*L1*S340C*sub-340c~
N1*BY*BY_BusinessName*UL*1233331013600~
N3*BY_Address1*BY_Address2~
N4*BY_City*CA*BY_PostCd*US~
REF*PO*PONumber~
REF*1W*AC*Acute Care~
SII*ND*123422*10*EA*5.98*6.98*20.76~
N9*DI*4567892*123422ABCD*20250311***L1:s170:P7:s172:SE:s174~
N1*BG*BG_BusinessName*UL*1333331013600~
N3*BG_Address1*BG_Address2~
N4*BG_City*CA*BG_PostCd*US~
REF*PO*PONumber~
REF*9X*AC*Acute Care~
SII*ND*123422*10*EA*5.98*6.98*20.76~
N9*DI*4567892*123422ABCD*20250311***L1:s170:P7:s172:SE:s174~
N1*EC*EC_BusinessName*UL*1433331013600~
N3*EC_Address1*EC_Address2~
N4*EC_City*CA*EC_PostCd*US~
REF*PO*PONumber~
REF*ACD*AC*Acute Care~
SII*ND*123422*10*EA*5.98*6.98*20.76~
N9*DI*4567892*123422ABCD*20250311***L1:s170:P7:s172:SE:s174~
N1*ST*ST_BusinessName*UL*1533331013600~
N3*ST_Address1*ST_Address2~
N4*ST_City*CA*ST_PostCd*US~
REF*PO*PONumber~
REF*1W*AC*Acute Care~
SII*ND*123422*10*EA*5.98*6.98*20.76~
N9*DI*4567892*123422ABCD*20250311***L1:s170:P7:s172:SE:s174~
PAD*1*SD*AI~
LIN*0001*BP*s236*UP*s238*UK*s240*MF*s242*VN*s244*UX*s246*NH*s248*N1*s250*N2*s252*N3*s254*N4*s256*N5*s258*ND*s260*N6*s262*BP*s264~
UIT*UN*266*CT~
UIT*CA*277*WH~
QTY*39*268*EA~
REF*LI*45678~
DTM*011*20250311~
CTT*272~
AMT*CE*350*C~
SE*284*s285~
GE*286*287~
IEA*288*289111111~ 

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