| 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
3157471
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780672
MR00389371
00
03/22/2021
03/22/2021
03/23/2021
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
80
44.44400
Replenished
1001879330
3059650533
False
3151679
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780672
MR00389371
00
03/22/2021
03/22/2021
03/23/2021
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
100
55.55600
Replenished
1001830087
3050733659
False
3456006
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781588
MR00127279
00
04/30/2021
04/30/2021
05/01/2021
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
14
14
100.00000
Replenished
1001879330
3059650533
False
3823498
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782840
MR00389371
00
06/23/2021
06/23/2021
06/24/2021
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
6
3.33300
Replenished
1001879330
3059650533
False
3834892
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782840
MR00389371
00
06/23/2021
06/23/2021
06/24/2021
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
74
41.11100
Replenished
1001926498
3068455122
False
3834891
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782840
MR00389371
00
06/23/2021
06/23/2021
06/24/2021
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
100
55.55600
Replenished
1001879330
3059650533
False
4563455
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784959
MR00389371
00
09/21/2021
09/21/2021
09/22/2021
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
26
14.44400
Replenished
1001926498
3068455122
False
4568584
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784959
MR00389371
00
09/21/2021
09/21/2021
09/22/2021
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
54
30.00000
Replenished
1001978209
3078024705
False
4568583
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784959
MR00389371
00
09/21/2021
09/21/2021
09/22/2021
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
100
55.55600
Replenished
1001926498
3068455122
False
5258287
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787105
MR00389371
00
12/22/2021
12/22/2021
12/23/2021
60505014200
GLIPIZIDE 10 MG TABLET
10 MG
TABLET
100
180
34
18.88800
Replenished
1002024556
3087532840