| 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
2948698
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Cash 340B
000000779900
MR00182534
00
02/15/2021
02/15/2021
02/15/2021
50458057930
XARELTO 20 MG TABLET
20 MG
TABLET
30
30
30
100.00000
Replenished
1001811232
987509358
False
2958376
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Cash 340B
000000779959
MR00037445
00
02/17/2021
02/17/2021
02/17/2021
50458057930
XARELTO 20 MG TABLET
20 MG
TABLET
30
30
30
100.00000
Replenished
1001812276
987651857
False
3110953
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Cash 340B
000000780562
MR00182534
00
03/15/2021
03/15/2021
03/15/2021
50458057930
XARELTO 20 MG TABLET
20 MG
TABLET
30
30
30
100.00000
Replenished
1001826768
3050065356
False
3151674
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Cash 340B
000000780670
MR00037445
00
03/22/2021
03/22/2021
03/22/2021
50458057930
XARELTO 20 MG TABLET
20 MG
TABLET
30
30
30
100.00000
Replenished
1001830087
3050733659
False
3301337
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Cash 340B
000000781177
MR00182534
00
04/12/2021
04/12/2021
04/12/2021
50458057930
XARELTO 20 MG TABLET
20 MG
TABLET
30
30
30
100.00000
Replenished
1001842172
3052723058
False
3378834
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Cash 340B
000000781305
MR00037445
00
04/19/2021
04/19/2021
04/19/2021
50458057930
XARELTO 20 MG TABLET
20 MG
TABLET
30
30
30
100.00000
Replenished
1001845547
3053392934
False
3502084
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Cash 340B
000000781772
MR00108206
00
05/07/2021
05/07/2021
05/07/2021
50458057930
XARELTO 20 MG TABLET
20 MG
TABLET
30
30
30
100.00000
Replenished
1001855254
3055135221
False
3549272
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Cash 340B
000000781912
MR00182534
00
05/13/2021
05/13/2021
05/13/2021
50458057930
XARELTO 20 MG TABLET
20 MG
TABLET
30
30
30
100.00000
Replenished
1001858827
3055792360
False
3608370
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Cash 340B
000000782110
MR00037445
00
05/21/2021
05/21/2021
05/21/2021
50458057930
XARELTO 20 MG TABLET
20 MG
TABLET
30
30
30
100.00000
Replenished
1001862702
3056474257
False
3737016
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Cash 340B
000000782573
MR00108206
00
06/10/2021
06/10/2021
06/10/2021
50458057930
XARELTO 20 MG TABLET
20 MG
TABLET
30
30
30
100.00000
Replenished
1001872664
3058406459