| 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
5664472
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785781
MR00298158
02
02/16/2022
02/16/2022
02/17/2022
69097052444
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
300
100
33.33300
Replenished
1002007603
3084006129
False
5669383
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785781
MR00298158
02
02/16/2022
02/16/2022
02/17/2022
69097052444
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
300
100
33.33300
Replenished
1002007603
3084006129
False
5669384
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785781
MR00298158
02
02/16/2022
02/16/2022
02/17/2022
69097052444
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
300
100
33.33400
Replenished
1002007603
3084006129
False
5916747
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785781
MR00298158
03
03/21/2022
03/21/2022
03/22/2022
69097052444
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
300
100
33.33300
Replenished
1002023985
3087397632
False
5923178
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785781
MR00298158
03
03/21/2022
03/21/2022
03/22/2022
69097052444
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
300
100
33.33300
Replenished
1002023985
3087397632
False
5923179
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785781
MR00298158
03
03/21/2022
03/21/2022
03/22/2022
69097052444
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
300
100
33.33400
Replenished
1002023985
3087397632
False
2963035
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779990
MR00188111
00
02/18/2021
02/18/2021
02/19/2021
69097052444
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001814475
987756775
False
5550161
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000788004
MR00171522
00
01/31/2022
02/02/2022
02/03/2022
69097052444
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001999272
3082324547
False
3071207
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780453
MR00170923
00
03/10/2021
03/10/2021
03/11/2021
69097052444
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1001829917
3050598748
False
5569600
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000787562
MR00051059
00
02/03/2022
02/03/2022
02/04/2022
69097052444
DICLOFENAC SODIUM 1% GEL
1 %
GEL (GRAM)
100
100
100
100.00000
Replenished
1002001191
3082500309