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-submitted

Bundle bundle-chargeback-submitted of type message

Entry 1 - fullUrl = urn:uuid:11111111-1111-4111-8111-111111111111

Resource MessageHeader:

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

source

focus: Claim: extension = tx-1001,corr-9001,1.2.0,https://exchange.example.org/chargeback#cb-1001; status = active; type = Pharmacy; use = claim; created = 2026-04-24; priority = Normal

Entry 2 - fullUrl = urn:uuid:22222222-2222-4222-8222-222222222222

Resource Claim:

340B Exchange Transaction ID Extension: tx-1001

340B Correlation ID Extension: corr-9001

340B Rule Set Version Extension: 1.2.0

340B Chargeback Reference Extension: https://exchange.example.org/chargeback/cb-1001

status: Active

type: Pharmacy

use: Claim

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

created: 2026-04-24

insurer: Organization Example Manufacturer 77

provider: Organization Example Pharmacy 22

priority: Normal

Insurances

-SequenceFocalCoverage
*1trueCoverage: status = active

Items

-SequenceProductOrService
*100000-1111-22

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

Resource Patient:

Pat Example (no stated gender), DoB Unknown

Entry 4 - fullUrl = urn:uuid:44444444-4444-4444-8444-444444444444

Resource Organization:

name: Example Pharmacy 22

Entry 5 - fullUrl = urn:uuid:55555555-5555-4555-8555-555555555555

Resource Organization:

name: Example Manufacturer 77

Entry 6 - fullUrl = urn:uuid:66666666-6666-4666-8666-666666666666

Resource Coverage:

status: Active

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