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	2933914		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779859	MR00389502	00	02/11/2021	02/11/2021	02/12/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	30	30	100.00000	Replenished		1001811232	987509358
False	4040662		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779859	MR00389502	01	07/13/2021	07/13/2021	07/14/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	30	30	100.00000	Replenished		1001889580	3061517655
False	4806803		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000785777	MR00388213	00	10/25/2021	10/25/2021	10/26/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	30	30	100.00000	Replenished		1001948371	3071858707
False	5117233		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000786731	MR00388213	00	12/06/2021	12/06/2021	12/07/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	30	30	100.00000	Replenished		1001969736	3076071583
False	5461237		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000786731	MR00388213	01	01/21/2022	01/21/2022	01/22/2022	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	30	30	100.00000	Replenished		1001993278	3080996427
False	5664475		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000786731	MR00388213	02	02/16/2022	02/16/2022	02/17/2022	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	30	30	100.00000	Replenished		1002007603	3084006129
False	3350517		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774985	MR00210929	03	04/15/2021	04/15/2021	04/16/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	90	30	33.33300	Replenished		1001843888	3053146133
False	3357321		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774985	MR00210929	03	04/15/2021	04/15/2021	04/16/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	90	30	33.33300	Replenished		1001843888	3053146133
False	3357322		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000774985	MR00210929	03	04/15/2021	04/15/2021	04/16/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	90	30	33.33400	Replenished		1001843888	3053146133
False	4086975		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000783441	MR00210929	00	07/20/2021	07/20/2021	07/21/2021	68382009706	PAROXETINE HCL 10 MG TABLET	10 MG	TABLET	30	90	30	33.33300	Replenished		1001891615	3062304712