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	3410230		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000781420	MR00030201	00	04/22/2021	04/22/2021	04/22/2021	68001010600	DIVALPROEX SOD ER 500 MG TAB	500 MG	TAB.SR 24H	100	450	50	11.11200	Replenished		1001897770	3062993331
False	3403036		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000781420	MR00030201	00	04/22/2021	04/22/2021	04/22/2021	68001010600	DIVALPROEX SOD ER 500 MG TAB	500 MG	TAB.SR 24H	100	450	100	22.22200	Replenished		1001847629	3053810031
False	3410227		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000781420	MR00030201	00	04/22/2021	04/22/2021	04/22/2021	68001010600	DIVALPROEX SOD ER 500 MG TAB	500 MG	TAB.SR 24H	100	450	100	22.22200	Replenished		1001847629	3053810031
False	3410228		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000781420	MR00030201	00	04/22/2021	04/22/2021	04/22/2021	68001010600	DIVALPROEX SOD ER 500 MG TAB	500 MG	TAB.SR 24H	100	450	100	22.22200	Replenished		1001847629	3053810031
False	3410229		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000781420	MR00030201	00	04/22/2021	04/22/2021	04/22/2021	68001010600	DIVALPROEX SOD ER 500 MG TAB	500 MG	TAB.SR 24H	100	450	100	22.22200	Replenished		1001847629	3053810031
False	4147195		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000783640	MR00030201	00	07/28/2021	07/28/2021	07/28/2021	68001010600	DIVALPROEX SOD ER 500 MG TAB	500 MG	TAB.SR 24H	100	450	50	11.11100	Replenished		1001897770	3062993331
False	4153960		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000783640	MR00030201	00	07/28/2021	07/28/2021	07/28/2021	68001010600	DIVALPROEX SOD ER 500 MG TAB	500 MG	TAB.SR 24H	100	450	100	22.22200	Replenished		1001897770	3062993331
False	4153961		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000783640	MR00030201	00	07/28/2021	07/28/2021	07/28/2021	68001010600	DIVALPROEX SOD ER 500 MG TAB	500 MG	TAB.SR 24H	100	450	100	22.22200	Replenished		1001897770	3062993331
False	4153962		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000783640	MR00030201	00	07/28/2021	07/28/2021	07/28/2021	68001010600	DIVALPROEX SOD ER 500 MG TAB	500 MG	TAB.SR 24H	100	450	100	22.22200	Replenished		1001897770	3062993331
False	4153963		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Cash 340B	000000783640	MR00030201	00	07/28/2021	07/28/2021	07/28/2021	68001010600	DIVALPROEX SOD ER 500 MG TAB	500 MG	TAB.SR 24H	100	450	100	22.22300	Replenished		1001897770	3062993331