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	5733009		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788330	MR00082070	00	02/16/2022	02/16/2022	02/27/2022	49502010202	EPINEPHRINE 0.3 MG AUTO-INJECT	0.3MG/0.3	AUTO INJCT	2	2	2	100.00000	Replenished		1002012950	3084815368
False	10019914		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799365	MR00239553	00	07/26/2023	07/26/2023	07/27/2023	49502010202	EPINEPHRINE 0.3 MG AUTO-INJECT	0.3MG/0.3	AUTO INJCT	2	2	2	100.00000	Replenished	08/22/2023	1002251223	3141466060