{"text_format":"1","workbook":"xlsx","n_sheets":2,"sheets":["Preparer Information","Offer Information"],"not_rendered":{"charts":0,"images":0,"macros":1,"external_links":0,"defined_names":1,"comments":2,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Preparer Information","index":0,"n_rows":19,"n_cols":9,"rows_kept":19,"cut":false,"hidden":false,"merged":[[0,0,0,8],[2,4,2,5],[12,0,12,8],[14,1,14,8],[16,1,16,8],[18,1,18,8]]}
["Florida Medicaid AHCA - Supplemental Rebate Offer Form"]
[]
["Click Here for Instructions",null,"Tips for Completing Offer Form",null,"How to Save Offer Form"]
[]
["Company Name","Your Name"," Street Address"," City"," State","Zip Code           (5 digits only)","Phone Number","Fax"," E-mail                                 (required for automated email confirmation)"]
[]
[]
[]
[]
[]
[]
[]
["By submitting the attached offer(s) to the Prime Therapeutics FTP site, Manufacturer certifies:"]
[]
[null,"a. That the offer(s) submitted are firm offers that Manufacturer will not retract unless rejected as insufficient by Prime Therapeutics; and"]
[]
[null,"b. That Manufacturer will enter into a binding contract(s) incorporating the Manufacturer’s offer(s) that are accepted; and"]
[]
[null,"c. That Manufacturer understands and agrees that the acceptance of its offer(s) does not require any individual State to include Manufacturer’s offered product(s) on its preferred drug list"]

{"sheet":"Offer Information","index":1,"n_rows":503,"n_cols":30,"rows_kept":503,"cut":false,"hidden":false,"merged":[[6,8,6,10],[5,2,7,2],[5,4,5,5],[7,4,7,7],[6,4,6,5],[5,11,7,11],[4,2,4,11],[6,6,6,7],[4,0,4,1],[7,0,8,1],[0,0,0,11],[2,5,2,7],[7,8,7,10],[5,8,5,10],[5,6,5,7]]}
["Florida Medicaid AHCA-Supplemental Rebate Offer Form"]
[]
[]
[]
["SAVE ALL FORMS AS EXCEL 97-2003 ",null,"Offer Form Validation Checks and Errors"]
["How to Use\nThis Form","How to Complete",{"$f":"IF(SUM(AA11:AA503)>0,\"One or more GNUPs have been left blank. This indicates that you do not want to submit an offer on that NDC. Please confirm by putting a note in the notes column for that NDC.\",\"\")","v":""},null,{"$f":"IF(SUM(Y11:Y503)>0, \"URA column is either null, text, or 0.  Please correct.  If URA is unknown, please estimate.\", \"\")","v":""},null,{"$f":"IF(AB11>0, \"Company Name is missing. Please enter it into cell A11\", \"\")","v":""},null,{"$f":"IF((COUNTIF($I$11:$I$503,0)>0),\"One or more products have a GNUP of zero indicating a guaranteed rebate of 100% of WAC.  If you do not wish to offer a GNUP please leave the GNUP column blank.\", \"\")","v":""},null,null,{"$f":"IF(SUM(AD11:AD503)>0,\"The column, (Total rebate is at least 29.1% of AMP),  needs to be filled out for all rows.  One or more cells have currently been left blank.  Please use the drop down option in column K to complete this column with a YES or NO selection.\",\"\")","v":""}]
["How to Save Offer Form","Submit",null,{"$f":"IF(SUMPRODUCT(--(ISNUMBER(FIND({\"-\"},$D$11:$D$503))))>0,\"Please remove all dashes from your NDCs.\",\"\")","v":""},{"$f":"IF(SUM(V11:V503)>0, \"WAC price is  either null, text, or 0.  A WAC price is REQUIRED for all products.\", \"\")","v":""},null,{"$f":"IF(SUMPRODUCT(--(Q12:Q503<Q11:Q502))>0,\"Please do not leave any blank rows between offer lines\",\"\")","v":""},null,{"$f":"IF(COUNTIF($N$11:$N$503,\"SRPU >70%\")>0, \"The Supplemental Rebate is greater than 70% off WAC for one or more of your NDCs. They are indicated in column M. Please verify this is your intent before submission.\", \"\")","v":""}]
["Roll cursor over each of these \nboxes to see the contents",null,null,{"$f":"IF(SUMPRODUCT((D11:D503=\"\")+(LEN(D11:D503)=11))=ROWS(D11:D503)=FALSE, \"All NDCs must \nbe eleven digits.\",\"\")","v":""},{"$f":"IF(COUNTIF($M$11:$M$503,\"NSRPU\")>0, \"One or more of the GNUPS entered creates  a negative supplemental rebate.  They are indicated with a  NSRPU in column L.  Please verify this is your intent before submission.\", \"\")","v":""},null,null,null,{"$f":"IF(COUNTIF($O$11:$O$503,\"Total Rebate >90%\")>0, \"The Total Rebate (Federal+Supplemental) is greater than 90% off WAC for one or more of your NDCs. They are indicated in column N. Please verify this is your intent before submission.\", \"\")","v":""}]
[]
["State","Company Name","Product Description","NDC Number","Pricing Effective Date","Price Source","WAC Price Per Unit      (Required)","Calculation Type","Guaranteed Net Unit Price","Federal Unit Rebate Amount (URA)         (Required)","Total rebate is at least 29.1% of AMP","Notes",null,null,null,"Missing wac or federal","Blank Row Checker","Supp","WAC, GNUP, or URA are blank or text","WAC is Text","WAC is 0/blank","WAC sum","URA is Text","URA is 0/blank","URA sum","GNUP=0","GNUP=Blank","Company Name Missing","GNUP SUM","% Rebate drop down column"]
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["FL",null,null,null,"2nd Qtr 25, Last Day","WAC",null,"GNUP",null,null,null,null,0,0,0,0,1,0,true,"0",0,0,"0",0,0,0,0,0,0,0]
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