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	7438849		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793116	MR00195463	00	09/27/2022	09/27/2022	09/28/2022	59746021601	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	30	10	33.33300	Replenished		1001782104
False	7432948		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793116	MR00195463	00	09/27/2022	09/27/2022	09/28/2022	59746021601	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	30	20	66.66700	Replenished		1002112953	3107698264
False	6212004		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789928	MR00195463	00	04/30/2022	04/30/2022	05/01/2022	59746021601	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	30	30	100.00000	Replenished		1002112953	3107698264
False	6194883		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789888	MR00288026	00	04/28/2022	04/28/2022	04/29/2022	59746021601	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	90	40	44.44400	Replenished		1002051432	3092898161
False	6200875		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789888	MR00288026	00	04/28/2022	04/28/2022	04/29/2022	59746021601	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	90	50	55.55600	Replenished		1002112953	3107698264
False	6148743		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788696	MR00095217	03	04/21/2022	04/21/2022	04/22/2022	59746021601	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	15	15	100.00000	Replenished		1002051432	3092898161
False	6044725		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788696	MR00095217	02	04/08/2022	04/08/2022	04/09/2022	59746021601	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	15	15	100.00000	Replenished		1002051432	3092898161
False	5965891		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784566	MR00389484	03	03/29/2022	03/29/2022	03/30/2022	59746021601	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	60	30	50.00000	Replenished		1002027177	3088118830
False	5973467		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784566	MR00389484	03	03/29/2022	03/29/2022	03/30/2022	59746021601	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	60	30	50.00000	Replenished		1002051432	3092898161
False	5878818		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788696	MR00095217	01	03/17/2022	03/17/2022	03/18/2022	59746021601	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	15	15	100.00000	Replenished		1002027177	3088118830