340B FHIR Exchange Implementation Guide
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340B FHIR Exchange Implementation Guide - Local Development build (v0.1.0-ballot) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Example Bundle: bundle-chargeback-adjudicated

Bundle bundle-chargeback-adjudicated of type message

Entry 1 - fullUrl = urn:uuid:77777777-7777-4777-8777-777777777777

Resource MessageHeader:

event: events: 340b.chargeback.adjudicated (340b.chargeback.adjudicated)

source

focus: ClaimResponse: extension = tx-1002,corr-9001; status = active; type = Pharmacy; use = claim; created = 2026-04-24; outcome = complete; disposition = Approved

Entry 2 - fullUrl = urn:uuid:88888888-8888-4888-8888-888888888888

Resource ClaimResponse:

340B Exchange Transaction ID Extension: tx-1002

340B Correlation ID Extension: corr-9001

status: Active

type: Pharmacy

use: Claim

patient: Pat Example (no stated gender), DoB Unknown

created: 2026-04-24

insurer: Organization Example Manufacturer 77

request: https://example.org/fhir/Claim/claim-340b-1001

outcome: complete

disposition: Approved

item

itemSequence: 1

adjudication

category: allowed

Amounts

-ValueCurrency
*125.42USD

Entry 3 - fullUrl = urn:uuid:33333333-3333-4333-8333-333333333333

Resource Patient:

Pat Example (no stated gender), DoB Unknown

Entry 4 - fullUrl = urn:uuid:55555555-5555-4555-8555-555555555555

Resource Organization:

name: Example Manufacturer 77