Claim Details
CLM-2024-89267
CLM-2024-89267
SPA PendingJohnson & Johnson SPA 2024
Claim Amount
$225.00
Recipient
Johnson & Johnson
ManufacturerContract
SPA-JJ-2024-001
Rebate Rate
5.0%
Created
Nov 26, 2024
2:30 AM
Transaction Details
Transaction ID
TXN-2024-892341Customer
Memorial Hospital
Product NDC
12345-678-90
Product Name
Pharmaceutical Product ABC 100mg
Calculation Breakdown
Quantity
100
Unit Price
$45.00
Extended Amount
$4,500.00
Extended Amount
$4,500.00
Rebate Rate
5.0%
Rebate Amount
$225.00
Claim History
Claim Created
Nov 26, 2024 2:30 AM
Claim generated from transaction TXN-2024-892341
Amount Calculated
Nov 26, 2024 2:30 AM
Rebate of $225.00 calculated at 5.0% rate
Added to Submission
Nov 26, 2024 2:35 AM
Claim added to submission batch SUB-2024-1126-001
Edit Claim Amount
$225.00
$