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	4487870		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000776643	MR00097587	11	09/10/2021	09/10/2021	09/11/2021	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	30	20	66.66700	Replenished		1001922312	3067326646
False	9217217		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790420	MR00018670	11	04/25/2023	04/25/2023	04/26/2023	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	90	10	11.11100	Replenished	05/30/2023	1002224253	3134810060
False	9209542		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790420	MR00018670	11	04/25/2023	04/25/2023	04/26/2023	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	90	80	88.88900	Replenished	05/02/2023	1002210717	3131427601
False	4248752		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000776643	MR00097587	10	08/11/2021	08/11/2021	08/12/2021	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	30	30	100.00000	Replenished		1001922312	3067326646
False	8187341		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788455	MR00097587	10	12/28/2022	12/28/2022	01/01/2023	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	30	30	100.00000	Replenished		1002167601	3121067798
False	8948367		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790420	MR00018670	10	03/27/2023	03/27/2023	03/28/2023	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	90	10	11.11100	Replenished		1001804274
False	8945421		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790420	MR00018670	10	03/27/2023	03/27/2023	03/28/2023	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	90	80	88.88900	Replenished		1002195747	3128183260
False	4034054		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000776643	MR00097587	09	07/12/2021	07/12/2021	07/13/2021	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	30	30	100.00000	Replenished		1001889250	3061354275
False	7890404		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788455	MR00097587	09	11/23/2022	11/23/2022	11/24/2022	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	30	30	100.00000	Replenished		1002152667	3117383035
False	8663275		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790420	MR00018670	09	02/23/2023	02/23/2023	02/24/2023	50111064701	FLUOXETINE HCL 10 MG CAPSULE	10 MG	CAPSULE	100	90	20	22.22200	Replenished		1002195747	3128183260