 100  01 JUL 2025 1.24127.000.00  100  300 The Payment date for the dispensing month of MAY       2025 will be 01-AUG-25. If you do not receive your file by the payment date, please contact Contractor Payments Section.
 200QXX  FXXXX                                          TEST PHARMACY                           AAAA                          AAAA                          AAAA                          AAAA                          AAAA    AAAA                                    AAAA                          AAAA                          AAAA                          AAAA                          AAAA           AAAA                                    ****9999                    99-99-999BACS   -108530.37April 2025         175.00         0.00         0.00         0.00   -109025.37   -108530.37         0.00
 300  FXXXX  QXX  FXXXX  AAAA                                    AAAA                                    AAAA                          AAAA                          AAAA                          AAAA                                                APR 2025   -108530.37    75    56    23     1     2 5.72  106                                            79     0     4   -123663.50    30 9.35     0 9.15       175.00AUGUST     7132   374                                      -108780.37         0.00APR 2025      1030.70       -87.40     12364.95         7.50         1.31         0.00         0.00         0.00         0.00        89.27         0.00     0.00    20.00    10.40     0.00     0.00     3.01         0.56          0.00       244.40         0.00      -280.50         0.00         0.00     13308.25     13403.44       295.31      1762.88      -317.34     14848.98     14531.64         0.00         0.00         0.00       250.00     0     2         0.00         0.00         0.00         0.00         0.00       394.88   -109025.37         6.80         0.00         0.00         0.00     0     0       280.00    31      65        10.30         4.10         0.00        10.70       405.00       500.00        12.28      -195.00      -210.85         0.00         0.00        70.00         0.00        20.00        30.00        40.00        60.00        18.00        50.00       160.00         0.00
 305     Total                                             13395.65                  -87.40       13308.25     
 305     Generic                                           78.96        17.52        -13.83       65.13        
 305     Branded                                           390.50       5.00         -19.53       370.97       
 305     Appliances                                        207.32       9.85         -20.42       186.90       
 305     DND                                               12362.44     0.00         0.00         12362.44     
 305     Sub total (Prescriptions)                         13039.22                  -53.78       12985.44     
 305     Generic (PFCP)                                    83.31        17.52        -14.60       68.71        
 305     Branded (PFCP)                                    108.68       5.00         -5.43        103.25       
 305     Appliances (PFCP)                                 113.27       9.85         -11.16       102.11       
 305     DND (PFCP)                                        2.51         0.00         0.00         2.51         
 305     Sub total (PFCP)                                  307.77                    -31.19       276.58       
 305     Branded (Contraception)                           48.66        5.00         -2.43        46.23        
 305     Sub total (Contraception)                         48.66                     -2.43        46.23        
 305     DND (Influenza)                                   0.00         0.00         0.00         0.00         
 305     Sub total (Influenza)                             0.00                      0.00         0.00         
 306     PFCP PGD Generic                                  75.11        61.95        0.00         0.00         
 306     PFCP PGD Branded                                  74.87        71.13        0.00         0.00         
 306     PFCP PGD DND                                      0.00         0.00         0.00         0.00         
 306     PFCP Non-PGD Generic                              8.20         6.76         20.00        1.35         
 306     PFCP Non-PGD Branded                              33.81        32.12        20.00        6.42         
 306     PFCP Non-PGD Appliance                            22.23        20.04        20.00        4.01         
 306     PFCP Non-PGD DND                                  2.51         2.51         20.00        0.50         
 306     Total                                             307.77       276.58                    12.28        
 307     Total                                             106                       1.31         
 307     Prescription                                      79           1.24         0.98         
 307     PFCP                                              27           1.24         0.33         
 308     Total                                             41                        4.10         
 308     Prescription                                      32           10.00        3.20         
 308     PFCP                                              9            10.00        0.90         
 309     Total                                             34                        -317.90      
 309     Excluding elastic hosiery                         20           9.35         -187.00      
 309     Excluding elastic hosiery old rate                0            9.15         0.00         
 309     Elastic hosiery                                   2            9.35         -18.70       
 309     Elastic hosiery old rate                          0            9.15         0.00         
 309     Sub total (Prescriptions)                         22                        -205.70      
 309     Excluding elastic hosiery (PFCP)                  10           9.35         -93.50       
 309     Excluding elastic hosiery old rate (PFCP)         0            9.15         0.00         
 309     Elastic hosiery (PFCP)                            2            9.35         -18.70       
 309     Sub total (PFCP)                                  12                        -112.20      
 310     APRIL 2022 (Band 03)                              14           0            0            0.00         
 310     MAY 2022 (Band 03)                                14           3            3            -45.00       
 310     JUNE 2022 (Band 03)                               14           4            4            -60.00       
 310     JULY 2022 (Band 03)                               14           20           6            -90.00       
 311     APRIL 2022                                        MAY 2022     15           0            1            
 311     MAY 2022                                          MAY 2022     18           0            4            
 311     JUNE 2022                                         JUN 2022     24           0            10           
 311     JULY 2022                                         JUL 2022     20           0            6            
 312     Total                                             48.66        46.23                     0.00         
 312     Contraception Branded                             48.66        46.23        0.00         0.00         
 313     Total                                             0.00         0.00                      70.00        
 313     Influenza DND                                     0.00         0.00         20.00        70.00        
 400         -37.40   123.68      0      0
 500    3065Cont Service Incentive 2 Payment                                             250.00
 600    112 Exempt to Chargeable                              3
 600    112D   contains charge rate                           3
 600    113 Exempt to Chargeable (old rate)                   0
 600    121 Chargeable to Exempt                              0
 600    131 Chargeable (old rate) to Exempt                   0
 600    2XA Under 16                                          0
 600    2XC 60 or over                                        0
 700         4    12220.00     0        0.00     4     12220.00
 800     00002/1ZOLADEX LA 10.8MG IMPLANT SAFESYSTEM PR 1                       1.00     20   4700.00N00002
 800     00009/1ZOLADEX LA 10.8MG IMPLANT SAFESYSTEM PR 1                       1.00     12   2820.00A00009
 800     00018/2ZOLADEX LA 10.8MG IMPLANT SAFESYSTEM PR 1                       1.00     10   2350.00A00018
 800     00008/2ZOLADEX LA 10.8MG IMPLANT SAFESYSTEM PR 1                       1.00     10   2350.00A00008
9999      1    -108530.37
