Patient : Third Party

Patient

Prescriber

Drug

info

Created By/On: Devel# 11/26/2015 | 5:23:47 AM

Maintained By/On: Jayden Smith 02/12/2018 | 5:06:479 AM

Name: Maria Rodriguez
DOB: 10/07/1976
Patient Type: Compliance Packaging , Care Facility Patient

3rd Party

Plan	Status	Relationship to Cardholder	BIN	PCN	Online Adj	Card Owner
D.O Primary Insurance	Active	Head of Household	0015553		Y
Avia Corporate Plan	Inactive	Spouse	0015553	DOCER	Y
Nimbus Prima Plan	Active	Not Specified	0015553	DOCER	N
Third Party Plan	Inactive	Spouse	0015553	DOCER	Y

Search Criteria

Plan, Payer, or Group

BIN

Plan	Bin	PCN	Payer	Group	Plan Id	Status
2008CF Corporate Plan	001552	DOCER	2008CF	2008CF Group		Active
340D Prima Plan	001792	DOCER	340D	340D		Active
Eligiblity Commercial Plan	001898		CMS 1500			Active
CMS 1500 Claim Form			CMS 1500			Active

Search Criteria

Date of Birth

Enter last name, first name

MRN

Phone

Address

City

State

ZIP

Name	Date of Birth	Address	City	State	ZIP	Phone	CF	Status
Smith James	10/07/1978	88 Center Rd	Bedford	OH	44146	715-361-4850		Active
Rodriguez Maria	10/07/1976	2349 Spinnaker Lane	Joliet	LA	60432	724-376-4350		Active
Smith James	10/07/1978	1566 Elm Drive	Cambridge	NY	12816	532-247-7219		Active

Search Criteria

Date of Birth

Enter last name, first name

MRN

Phone

Address

City

State

ZIP

Name	Date of Birth	Address	City	State	ZIP	Phone	CF	Status
Smith James	10/07/1978	88 Center Rd	Bedford	OH	44146	715-361-4850		Active
Rodriguez Maria	10/07/1976	2349 Spinnaker Lane	Joliet	LA	60432	724-376-4350		Active
Smith James	10/07/1978	1566 Elm Drive	Cambridge	NY	12816	532-247-7219		Active