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	8637263		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794319	MR00041824	01	02/20/2023	02/20/2023	02/21/2023	29300041901	AMITRIPTYLINE HCL 10 MG TAB	10 MG	TABLET	100	90	90	100.00000	Replenished		1002185066	3125534406
False	9428843		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794319	MR00041824	02	05/19/2023	05/19/2023	05/20/2023	29300041901	AMITRIPTYLINE HCL 10 MG TAB	10 MG	TABLET	100	90	10	11.11100	Replenished	06/09/2023	1002231800	3136126192
False	9423153		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000794319	MR00041824	02	05/19/2023	05/19/2023	05/20/2023	29300041901	AMITRIPTYLINE HCL 10 MG TAB	10 MG	TABLET	100	90	80	88.88900	Replenished	05/22/2023	1002222095	3134071095
False	9065566		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796124	MR00116621	01	04/07/2023	04/07/2023	04/08/2023	29300041901	AMITRIPTYLINE HCL 10 MG TAB	10 MG	TABLET	100	30	30	100.00000	Replenished	05/19/2023	1002221549	3133876132
False	9276610		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796124	MR00116621	02	05/01/2023	05/01/2023	05/04/2023	29300041901	AMITRIPTYLINE HCL 10 MG TAB	10 MG	TABLET	100	30	30	100.00000	Replenished	05/19/2023	1002221549	3133876132
False	9562788		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796124	MR00116621	03	06/01/2023	06/01/2023	06/03/2023	29300041901	AMITRIPTYLINE HCL 10 MG TAB	10 MG	TABLET	100	30	30	100.00000	Replenished	06/09/2023	1002231800	3136126192
False	9817053		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796124	MR00116621	04	06/29/2023	06/29/2023	06/30/2023	29300041901	AMITRIPTYLINE HCL 10 MG TAB	10 MG	TABLET	100	30	30	100.00000	Replenished	07/03/2023	1002239529	3138618794
False	10078233		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796124	MR00116621	05	08/03/2023	08/03/2023	08/04/2023	29300041901	AMITRIPTYLINE HCL 10 MG TAB	10 MG	TABLET	100	30	10	33.33300	Replenished	08/14/2023	1002254688	3143269122
False	10073052		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796124	MR00116621	05	08/03/2023	08/03/2023	08/04/2023	29300041901	AMITRIPTYLINE HCL 10 MG TAB	10 MG	TABLET	100	30	20	66.66700	Replenished	08/22/2023	1002253074	3142468422
False	10118243		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799671	MR00154246	00	08/10/2023	08/10/2023	08/11/2023	29300041901	AMITRIPTYLINE HCL 10 MG TAB	10 MG	TABLET	100	30	30	100.00000	Replenished	08/14/2023	1002254688	3143269122