4729-37-04 Information required for submission.

(A) Pharmacies pursuant to paragraphs (A) and (B) of rule 4729-37-03 of the Administrative Code that dispense drugs identified in rule 4729-37-02 of the Administrative Code to outpatients residing in this state must report the following dispensing information to the board of pharmacy:

(1) Pharmacy drug enforcement administration registration number;

(2) Pharmacy name;

(3) Pharmacy address;

(4) Pharmacy telephone number;

(5) Patient full name;

(6) Patient address;

(7) Patient telephone number;

(8) Patient date of birth;

(9) Patient gender;

(10) Prescriber’s drug enforcement administration registration number;

(11) Date prescription was issued by the prescriber;

(12) Date the prescription was dispensed by the pharmacy;

(13) Indication of whether the prescription dispensed is new or a refill;

(14) Number of the refill being dispensed;

(15) National drug code of the actual drug dispensed;

(16) Quantity of drug dispensed;

(17) Number of days’ supply of drug dispensed;

(18) Serial or prescription number assigned to the prescription order;

(19) Source of payment for the prescription that indicates one of the following: private pay (cash), medicaid, medicare, commercial pharmacy benefit manager (PBM) insurance, major medical, or workers’ compensation.

(B) Wholesalers and pharmacies pursuant to paragraphs (C) and (D) of rule 4729-37-03 of the Administrative Code that sell drugs identified in rule 4729-37-02 of the Administrative Code at wholesale must report the following information to the board of pharmacy in the following sequence:

(1) Wholesaler or pharmacy drug enforcement administration registration number;

(2) Purchaser’s drug enforcement administration registration number;

(3) National drug code number of the actual drug sold;

(4) Quantity of the drug sold;

(5) Date of sale.

Effective: 10/19/2007

R.C. 119.032 review dates: 12/31/2010

Promulgated Under: 119.03

Statutory Authority: 3719.28, 4729.26, 4729.83

Rule Amplifies: 4729.75, 4729.76, 4729.77, 4729.78, 4729.79, 4729.80, 4729.81, 4729.82, 4729.83, 4729.84

Prior Effective Dates: 1/1/06, 4/27/07