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	10154872		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000798514	MR00055148	02	08/14/2023	08/14/2023	08/15/2023	57237010201	METOPROLOL TARTRATE 100 MG TAB	100 MG	TABLET	100	30	10	33.33300	Replenished	08/22/2023	1002261096	3144239974
False	9972262		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799209	MR00251734	00	07/19/2023	07/19/2023	07/20/2023	57237010201	METOPROLOL TARTRATE 100 MG TAB	100 MG	TABLET	100	90	90	100.00000	Replenished	08/22/2023	1002261096	3144239974