| Contract Pharmacy
Accumulator - View By Claim
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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
True
9869604
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00002149580
MOUNJARO 5 MG/0.5 ML PEN
5 MG/0.5ML
PEN INJCTR
2
0
2
0.00000
Suspended
07/06/2023
1002240468
3138951861
True
8425064
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00002223680
TRULICITY 3 MG/0.5 ML PEN
3 MG/0.5ML
PEN INJCTR
2
0
2
0.00000
Suspended
1002168499
3121399108
True
2933655
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00002446430
CIALIS 20 MG TABLET
20 MG
TABLET
30
0
1
0.00000
Suspended
1000541010
True
2933653
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00002446430
CIALIS 20 MG TABLET
20 MG
TABLET
30
0
30
0.00000
Suspended
1000541010
True
2933652
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00008121130
PRISTIQ ER 50 MG TABLET
50 MG
TAB.SR 24H
30
0
30
0.00000
Suspended
1000930509
True
2934041
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00054485925
TRIAZOLAM 0.25 MG TABLET
0.25 MG
TABLET
100
0
10
0.00000
Suspended
1001744025
True
2933538
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00069046903
CHANTIX 1 MG CONT MONTH BOX
1 MG
TABLET
56
0
56
0.00000
Suspended
1001597272
True
2933648
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00093720656
MIRTAZAPINE 15 MG TABLET
15 MG
TABLET
30
0
30
0.00000
Suspended
1001180414
True
2933647
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00093720656
MIRTAZAPINE 15 MG TABLET
15 MG
TABLET
30
0
30
0.00000
Suspended
1001190165
True
2933646
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
00093720656
MIRTAZAPINE 15 MG TABLET
15 MG
TABLET
30
0
30
0.00000
Suspended
1001197944