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	3020601		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000780225	MR00021548	00	03/01/2021	03/01/2021	03/01/2021	33342010937	RISEDRONATE SODIUM 35 MG TAB	35 MG	TABLET	4	4	4	100.00000	Replenished		1001819373	988099025
False	3256726		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000780992	MR00021548	00	04/05/2021	04/05/2021	04/05/2021	33342010937	RISEDRONATE SODIUM 35 MG TAB	35 MG	TABLET	4	4	4	100.00000	Replenished		1001837395	3052058131
False	3485904		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000780992	MR00021548	01	05/05/2021	05/05/2021	05/05/2021	33342010937	RISEDRONATE SODIUM 35 MG TAB	35 MG	TABLET	4	4	4	100.00000	Replenished		1001853845	3055068759
False	3760404		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000780992	MR00021548	02	06/14/2021	06/14/2021	06/14/2021	33342010937	RISEDRONATE SODIUM 35 MG TAB	35 MG	TABLET	4	4	4	100.00000	Replenished		1001874393	3058663336
False	4040674		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000780992	MR00021548	03	07/13/2021	07/13/2021	07/13/2021	33342010937	RISEDRONATE SODIUM 35 MG TAB	35 MG	TABLET	4	4	4	100.00000	Replenished		1001889580	3061517655
False	4189731		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000783729	MR00021548	00	08/03/2021	08/03/2021	08/03/2021	33342010937	RISEDRONATE SODIUM 35 MG TAB	35 MG	TABLET	4	4	4	100.00000	Replenished		1001899296	3063578940
False	4458952		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000783729	MR00021548	01	09/07/2021	09/07/2021	09/07/2021	33342010937	RISEDRONATE SODIUM 35 MG TAB	35 MG	TABLET	4	4	4	100.00000	Replenished		1001919113	3067013098
False	4660387		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000784572	MR00021548	00	10/04/2021	10/04/2021	10/04/2021	33342010937	RISEDRONATE SODIUM 35 MG TAB	35 MG	TABLET	4	4	4	100.00000	Replenished		1001935866	3069727219
False	4859407		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000785910	MR00021548	00	11/01/2021	11/01/2021	11/01/2021	33342010937	RISEDRONATE SODIUM 35 MG TAB	35 MG	TABLET	4	4	4	100.00000	Replenished		1001951777	3072578295
False	5059600		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000786536	MR00021548	00	11/29/2021	11/29/2021	11/29/2021	33342010937	RISEDRONATE SODIUM 35 MG TAB	35 MG	TABLET	4	4	4	100.00000	Replenished		1001965091	3075301281