| Contract Pharmacy
Back
Accumulator - View By Claim
Export to Excel
Health Center:
Memorial Hospital
Pharmacy:
Trapp Pharmacy (#1)
Capture Date :
To:
Fetching results...
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
3006958
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780215
MR00378136
00
02/27/2021
02/27/2021
02/28/2021
45802006435
TRIAMCINOLONE 0.1% CREAM
0.1 %
CREAM(GM)
15
15
15
100.00000
Replenished
1001818667
988063364
False
3048366
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780335
MR00410512
00
03/05/2021
03/05/2021
03/06/2021
45802006435
TRIAMCINOLONE 0.1% CREAM
0.1 %
CREAM(GM)
15
15
15
100.00000
Replenished
1001822785
3049139689
False
3238003
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000780948
MR00124995
00
04/01/2021
04/01/2021
04/02/2021
45802006435
TRIAMCINOLONE 0.1% CREAM
0.1 %
CREAM(GM)
15
15
15
100.00000
Replenished
1001836082
3051817901
False
4298888
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784082
MR00195463
00
08/17/2021
08/17/2021
08/18/2021
45802006435
TRIAMCINOLONE 0.1% CREAM
0.1 %
CREAM(GM)
15
15
15
100.00000
Replenished
1001858827
3055792360
False
4478904
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000784673
MR00082070
00
09/09/2021
09/09/2021
09/10/2021
45802006435
TRIAMCINOLONE 0.1% CREAM
0.1 %
CREAM(GM)
15
15
15
100.00000
Replenished
1001921962
3067326644
False
4606562
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785077
MR00234113
00
09/27/2021
09/27/2021
09/28/2021
45802006435
TRIAMCINOLONE 0.1% CREAM
0.1 %
CREAM(GM)
15
15
15
100.00000
Replenished
1001928804
3069023028
False
5144008
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785077
MR00234113
01
12/09/2021
12/09/2021
12/10/2021
45802006435
TRIAMCINOLONE 0.1% CREAM
0.1 %
CREAM(GM)
15
15
15
100.00000
Replenished
1001975684
3077386382
False
6161788
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785164
MR00050302
01
04/22/2022
04/22/2022
04/23/2022
45802006435
TRIAMCINOLONE 0.1% CREAM
0.1 %
CREAM(GM)
15
80
5
6.25000
Replenished
1002099459
3104747366
False
6157403
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785164
MR00050302
01
04/22/2022
04/22/2022
04/23/2022
45802006435
TRIAMCINOLONE 0.1% CREAM
0.1 %
CREAM(GM)
15
80
15
18.75000
Replenished
1002041590
3090640344
False
6161784
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000785164
MR00050302
01
04/22/2022
04/22/2022
04/23/2022
45802006435
TRIAMCINOLONE 0.1% CREAM
0.1 %
CREAM(GM)
15
80
15
18.75000
Replenished
1002041590
3090640344