| 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
2934132
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779679
MR00152015
00
02/05/2021
02/05/2021
02/06/2021
59746017506
PREDNISONE 20 MG TABLET
20 MG
TABLET
100
15
15
100.00000
Replenished
1001851763
3054766187
False
2934133
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779711
MR00260341
00
02/05/2021
02/05/2021
02/06/2021
59746017506
PREDNISONE 20 MG TABLET
20 MG
TABLET
100
10
2
20.00000
Replenished
1001807887
False
2934134
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779711
MR00260341
00
02/05/2021
02/05/2021
02/06/2021
59746017506
PREDNISONE 20 MG TABLET
20 MG
TABLET
100
10
8
80.00000
Replenished
1001851763
3054766187
False
2934131
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000779719
MR00328406
00
02/08/2021
02/08/2021
02/09/2021
59746017506
PREDNISONE 20 MG TABLET
20 MG
TABLET
100
11
11
100.00000
Replenished
1001851763
3054766187
False
2976615
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780089
MR00210929
00
02/22/2021
02/22/2021
02/23/2021
59746017506
PREDNISONE 20 MG TABLET
20 MG
TABLET
100
20
20
100.00000
Replenished
1001851763
3054766187
False
3280673
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781082
MR00194370
00
04/08/2021
04/08/2021
04/09/2021
59746017506
PREDNISONE 20 MG TABLET
20 MG
TABLET
100
5
5
100.00000
Replenished
1001851763
3054766187
False
3378815
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781283
MR00315442
00
04/19/2021
04/19/2021
04/20/2021
59746017506
PREDNISONE 20 MG TABLET
20 MG
TABLET
100
10
10
100.00000
Replenished
1001851763
3054766187
False
3433639
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781532
MR00386366
00
04/27/2021
04/27/2021
04/28/2021
59746017506
PREDNISONE 20 MG TABLET
20 MG
TABLET
100
26
26
100.00000
Replenished
1001851763
3054766187
False
3470743
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781637
5509
00
05/03/2021
05/03/2021
05/04/2021
59746017506
PREDNISONE 20 MG TABLET
20 MG
TABLET
100
10
5
50.00000
Replenished
1001851763
3054766187
False
3474199
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781637
5509
00
05/03/2021
05/03/2021
05/04/2021
59746017506
PREDNISONE 20 MG TABLET
20 MG
TABLET
100
10
5
50.00000
Replenished
1001872664
3058406459