A Purchase Validation, an account groups the purchase and claim activity associated with a specific manufacturer, covered entity, and one or more pharmacy or dispensing locations. Each account is evaluated separately to determine whether it remains eligible for that manufacturer's 340B pricing offers.
What is an account in Purchase Validation?
When validating purchases, 340B ESP creates an a account by grouping one or more pharmacies or dispensing locations for a specific covered entity and manufacturer network.
Each account is defined by a combination of:
Covered entity – The registered 340B covered entity associated with the account and responsible for submitting claims for the included locations.
Manufacturer – The manufacturer and associated policy under which the account’s purchases, claims, and eligibility are evaluated.
Included pharmacies or dispensing locations – The specific pharmacies or dispensing locations assigned to the account — identified using the Pharmacy ID (PID).
Purchases and claims are assigned to an account based on their identifier mappings. When submitted claims are validated, they are used to support purchases within that same account. The account’s eligibility is then evaluated based on the relationship between its mapped purchases and validated claims.
The account may be assigned an Eligible, At Risk, or Suspended status. That status applies to all pharmacies and dispensing locations included in the account. If the account is suspended, access to the manufacturer’s 340B pricing offer is suspended for every included location.
Account Types
Purchase Validation includes three types of accounts based on how pharmacies and dispensing locations are associated with a covered entity. Depending on the account type, an account may represent a single dispensing location or combine activity from multiple locations into one account.
The account type determines how purchases, submitted claims, and eligibility are grouped and evaluated under the manufacturer’s universal claims policy.
Individual Contract Pharmacy
An individual contract pharmacy account is created for a non-chain contract pharmacy. The contract pharmacy is evaluated as its own account for the applicable manufacturer network and covered entity.
What this means:
The account generally represents one contract pharmacy location.
The pharmacy’s validated purchases and submitted claims are evaluated together.
The account’s eligibility status applies to that contract pharmacy.
CE Pharmacies and Clinics
The CE Pharmacies and Clinics account type includes the CE owned pharmacies and clinics associated with a manufacturer for a covered entity.
All applicable CE pharmacies and clinics are treated in aggregate. Their validated purchases and submitted claims are grouped and evaluated together at the account level for the manufacturer.
What this means:
One account may include multiple CE Pharmacies and Clinics.
Claims and purchases from the included locations are evaluated together.
Eligibility and pricing access are determined for the account as a whole.
Contract Pharmacy Chain Account
A contract pharmacy chain account groups the applicable locations within a pharmacy chain into a single account. Validated purchases and submitted claims associated with the included chain locations are aggregated and evaluated together.
What this means:
One account may include multiple dispensing locations within the pharmacy chain.
Claims and purchasing activity are evaluated across the account as a whole.
The account’s eligibility status may affect pricing access for all locations included in the account.
The pharmacies and identifiers included in an account can be reviewed from the account details in Purchase Validation.
Note: Account composition and eligibility requirements may vary by manufacturer. Review the applicable universal claims policy and account details in Purchase Validation to confirm how locations are grouped and evaluated.
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