PFxxxx A0xx 01/03/2014 14:48 1 PRODUCTION

69645166387 1283-233-B A0xx PFxxxx 999-9999-9999999-9 231.20 0.00 231.20 PFxxxx 1 986254-1 01/02/2014 14:19 02/02/2014 14:19 4 Principal 250.02 Secondary 272.2 Secondary V58.69 Secondary 791.0 PFXXXX-DRUG-2108102 01/03/2014 14:24 5 1283-1143-002 2 71.20 GD1004 A0XX-PBM_8874246 PFXXXX-DRUG-2108101 01/03/2014 14:24 5 1528-2401-001 2 30.40 GD1004 A0XX-PBM_8874246 PFXXXX-DRUG-2108104 01/03/2014 14:24 5 1125-6212-001 1 93.60 GD1004 A0XX-PBM_8874246 PFXXXX-DRUG-2108103 01/03/2014 14:24 5 1125-6132-003 1.07143 36.00 GD1004 A0XX-PBM_8874246