View By Claim - BAR

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Accumulator - View By Claim

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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	9148380		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797351	MR00177615	00	04/17/2023	04/17/2023	04/18/2023	33342004910	IRBESARTAN 300 MG TABLET	300 MG	TABLET	90	90	90	100.00000	Replenished	04/19/2023	1002208692	3130511160
False	9920818		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797351	MR00177615	01	07/11/2023	07/11/2023	07/12/2023	33342004910	IRBESARTAN 300 MG TABLET	300 MG	TABLET	90	90	90	100.00000	Replenished	08/22/2023	1002247471	3140061852