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	7450395		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793220	MR00386503	00	09/30/2022	09/30/2022	10/01/2022	16729027730	METHOTREXATE 50 MG/2 ML VIAL	25 MG/ML	VIAL	2	10	2	20.00000	Replenished		1002113582	3107872087
False	7455716		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793220	MR00386503	00	09/30/2022	09/30/2022	10/01/2022	16729027730	METHOTREXATE 50 MG/2 ML VIAL	25 MG/ML	VIAL	2	10	2	20.00000	Replenished		1002113582	3107872087
False	7455717		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793220	MR00386503	00	09/30/2022	09/30/2022	10/01/2022	16729027730	METHOTREXATE 50 MG/2 ML VIAL	25 MG/ML	VIAL	2	10	2	20.00000	Replenished		1002113582	3107872087
False	7455718		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793220	MR00386503	00	09/30/2022	09/30/2022	10/01/2022	16729027730	METHOTREXATE 50 MG/2 ML VIAL	25 MG/ML	VIAL	2	10	2	20.00000	Replenished		1002113582	3107872087
False	7455719		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793220	MR00386503	00	09/30/2022	09/30/2022	10/01/2022	16729027730	METHOTREXATE 50 MG/2 ML VIAL	25 MG/ML	VIAL	2	10	2	20.00000	Replenished		1002113582	3107872087