| Contract Pharmacy
Back
Accumulator - View By Claim
Export to Excel
Health Center:
Memorial Hospital
Pharmacy:
Trapp Pharmacy (#1)
Capture Date :
To:
Fetching results...
Health
Center
Pharmacy
ShipTo
Claim
Type
RX
Number
Member ID
Fill
Fill Date
Adjud
Date
Captured
Date
NDC
Drug
Name
Strength
Form
Pkg
Size
QTY
Disp
Curr
QTY
% of
Claim
Status
Status
Date
Order
Wholesaler
Invoice
False
3182416
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780760
MR00030919
00
03/25/2021
03/25/2021
03/26/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
270
100
37.03700
Replenished
1001832780
3051158401
False
4293961
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784049
MR00030919
00
08/16/2021
08/16/2021
08/17/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
270
100
37.03700
Replenished
1001908104
3065555058
False
4293962
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784049
MR00030919
00
08/16/2021
08/16/2021
08/17/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
270
100
37.03700
Replenished
1001908104
3065555058
False
3390991
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781301
MR00248486
00
04/19/2021
04/20/2021
04/21/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
120
95
79.16700
Replenished
1001845547
3053392934
False
4007195
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783176
MR00248486
00
07/08/2021
07/08/2021
07/09/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
120
95
79.16700
Replenished
1001906780
3065449437
False
2933921
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779799
MR00361721
00
02/10/2021
02/10/2021
02/11/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
90
100.00000
Replenished
1001811232
987509358
False
2976632
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780077
MR00165004
00
02/22/2021
02/22/2021
02/23/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
90
100.00000
Replenished
1001819785
3048855808
False
3391011
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781343
MR00361721
00
04/20/2021
04/20/2021
04/21/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
90
100.00000
Replenished
1001846719
3053644954
False
3988919
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782141
MR00361721
01
07/06/2021
07/06/2021
07/07/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
90
90
100.00000
Replenished
1001906780
3065449437
False
3071217
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780432
MR00248486
00
03/10/2021
03/10/2021
03/11/2021
68382080501
TRAZODONE 50 MG TABLET
50 MG
TABLET
100
120
85
70.83300
Replenished
1001824882
3049647435