Use the Purchase Validation module in 340B ESP to monitor account eligibility and identify accounts that may require attention. Review each account’s eligibility status, investigate the purchases and claims contributing to that status, and determine whether additional claims are needed to maintain or restore manufacturer pricing eligibility.
Reviewing Accounts in Purchase Validation
Use the Purchase Validation module to review account eligibility statuses, purchases, and supporting claims.
Navigate to the Purchase Validation module.
Use the available filters to locate the account you want to review.
Review the At Risk or Suspended accounts table based on the account’s current eligibility status.
Select View Details for the applicable account.
Note: An account may include more than one pharmacy or dispensing location. Purchases and submitted claims from all included locations contribute to the account’s eligibility status. For more information about accounts and how they are constructed, check out Account in 340B ESP Purchase Validation.
Identifying Unvalidated Claims Using Account Details
In Account Details, review the Unvalidated Purchases to determine how many purchases still require supporting claims to maintain or restore the account’s Eligible status.
Then, use the Purchases by Product table to identify:
The applicable NDC-11
The number of Unvalidated Purchase Units
The Claim Units already submitted for the product
Use this information to determine which products may require additional claims and how many claim units may be needed to address the account’s unvalidated purchase balance.
In this example, four Unvalidated Purchases across three products have placed the account in an At Risk status. Additional claims must be submitted for these products to address the unvalidated purchase balance and maintain eligibility.
If the account is Suspended, access to the manufacturer’s 340B pricing offer is suspended at the account level. New purchases may not be eligible for 340B pricing while the suspension is in effect. However, covered entities should continue submitting applicable claims, including claims associated with purchases not made at 340B pricing, to reduce the unvalidated purchase balance and help restore eligibility.
After submitting the applicable claims, continue monitoring the account in Purchase Validation for changes to its eligibility status.
Tip: Learn more about submitting claims in 340B ESP in How to Submit Pharmacy Claims in 340B ESP and How to Submit Medical Claims in 340B ESP.
Using the Weekly Summary to Identify Accounts
Users associated with a covered entity that has at least one unvalidated purchase may receive a weekly At Risk and Suspended Accounts Summary email. The summary identifies accounts and pharmacies that may require attention and can help users determine which accounts to review in Purchase Validation.
After identifying an account in the summary, return to the Purchase Validation module to review its eligibility status and investigate the purchases and claims contributing to that status.
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