View By Claim - BAR

| Contract Pharmacy

Back

Accumulator - View By Claim

Export to Excel

Health Center:

Pharmacy:

Capture Date :

To:

			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	3729014		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000775890	MR00223267	02	06/09/2021	06/09/2021	06/10/2021	13668009690	PANTOPRAZOLE SOD DR 20 MG TAB	20 MG	TABLET DR	90	90	30	33.33300	Replenished		1001872170	3058237732
False	3734544		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000775890	MR00223267	02	06/09/2021	06/09/2021	06/10/2021	13668009690	PANTOPRAZOLE SOD DR 20 MG TAB	20 MG	TABLET DR	90	90	60	66.66700	Replenished		1001874393	3058663336
False	3056743		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000778331	MR00025513	01	03/08/2021	03/08/2021	03/09/2021	13668009690	PANTOPRAZOLE SOD DR 20 MG TAB	20 MG	TABLET DR	90	60	30	50.00000	Replenished		1001823796	3049396293
False	3059544		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000778331	MR00025513	01	03/08/2021	03/08/2021	03/09/2021	13668009690	PANTOPRAZOLE SOD DR 20 MG TAB	20 MG	TABLET DR	90	60	30	50.00000	Replenished		1001838628	3052278967
False	2933906		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779203	MR00025513	00	01/14/2021	01/14/2021	01/15/2021	13668009690	PANTOPRAZOLE SOD DR 20 MG TAB	20 MG	TABLET DR	90	60	60	100.00000	Replenished		1001823796	3049396293
False	2933904		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779203	MR00025513	01	02/09/2021	02/09/2021	02/10/2021	13668009690	PANTOPRAZOLE SOD DR 20 MG TAB	20 MG	TABLET DR	90	60	60	100.00000	Replenished		1001811232	987509358
False	2933905		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779715	MR00389243	00	02/08/2021	02/08/2021	02/09/2021	13668009690	PANTOPRAZOLE SOD DR 20 MG TAB	20 MG	TABLET DR	90	30	30	100.00000	Replenished		1001811232	987509358
False	3110980		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780531	MR00389243	00	03/15/2021	03/15/2021	03/16/2021	13668009690	PANTOPRAZOLE SOD DR 20 MG TAB	20 MG	TABLET DR	90	30	30	100.00000	Replenished		1001838628	3052278967
False	3378835		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780531	MR00389243	01	04/19/2021	04/19/2021	04/20/2021	13668009690	PANTOPRAZOLE SOD DR 20 MG TAB	20 MG	TABLET DR	90	30	30	100.00000	Replenished		1001853845	3055068759
False	3638939		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780531	MR00389243	02	05/26/2021	05/26/2021	05/27/2021	13668009690	PANTOPRAZOLE SOD DR 20 MG TAB	20 MG	TABLET DR	90	30	30	100.00000	Replenished		1001872170	3058237732