Generated Narrative: MessageHeader

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

Sources

-Endpoint
*urn:system:tpa-01

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

Generated Narrative: Claim claim-340b-1001

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

Generated Narrative: Patient p-001

Pat Example (no stated gender), DoB Unknown

Generated Narrative: Organization pharmacy-22

name: Example Pharmacy 22

Generated Narrative: Organization manufacturer-77

name: Example Manufacturer 77

Generated Narrative: Coverage cov-001

status: Active

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

payor: Organization Example Manufacturer 77