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	10052132		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796928	MR00296762	04	07/31/2023	07/31/2023	08/01/2023	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	60	60	100.00000	Replenished	08/22/2023	1002252361	3141976738
False	9880174		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799010	MR00082070	00	07/06/2023	07/06/2023	07/07/2023	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	90	40	44.44400	Replenished	08/22/2023	1002252361	3141976738
False	9873267		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799010	MR00082070	00	07/06/2023	07/06/2023	07/07/2023	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	90	50	55.55600	Replenished	08/22/2023	1002244869	3139279459
False	9866547		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798408	MR00389011	01	07/05/2023	07/05/2023	07/06/2023	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	60	10	16.66700	Replenished	08/22/2023	1002240777	3139104980
False	9869611		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798408	MR00389011	01	07/05/2023	07/05/2023	07/06/2023	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	60	50	83.33300	Replenished	08/22/2023	1002244869	3139279459
False	9774909		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796928	MR00296762	03	06/24/2023	06/24/2023	06/25/2023	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	60	60	100.00000	Replenished	08/22/2023	1002240777	3139104980
False	9595282		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798408	MR00389011	00	06/06/2023	06/06/2023	06/07/2023	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	60	30	50.00000	Replenished	06/08/2023	1002227496	3135977002
False	9603243		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798408	MR00389011	00	06/06/2023	06/06/2023	06/07/2023	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	60	30	50.00000	Replenished	08/22/2023	1002240777	3139104980
False	9544265		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796928	MR00296762	02	05/30/2023	05/30/2023	06/01/2023	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	60	60	100.00000	Replenished	06/08/2023	1002227496	3135977002
False	9406107		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797971	MR00279358	00	05/17/2023	05/17/2023	05/18/2023	64980028101	GLIPIZIDE ER 10 MG TABLET	10 MG	TAB ER2 24	100	90	30	33.33300	Replenished	05/19/2023	1002221549	3133876132