| Contract Pharmacy
Back
Accumulator - View By Claim
Export to Excel
Health Center:
Memorial Hospital
Pharmacy:
Trapp Pharmacy (#1)
Capture Date :
To:
Fetching results...
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
10171623
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797998
MR00392530
03
08/16/2023
08/16/2023
08/17/2023
55111064501
OMEPRAZOLE DR 40 MG CAPSULE
40 MG
CAPSULE DR
100
30
30
100.00000
Replenished
08/18/2023
1002260285
3143898442
False
10171633
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799759
MR00174136
00
08/16/2023
08/16/2023
08/17/2023
55111064501
OMEPRAZOLE DR 40 MG CAPSULE
40 MG
CAPSULE DR
100
30
20
66.66700
Replenished
08/18/2023
1002260285
3143898442
False
10132262
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000796439
MR00208636
02
08/11/2023
08/11/2023
08/12/2023
55111064501
OMEPRAZOLE DR 40 MG CAPSULE
40 MG
CAPSULE DR
100
30
30
100.00000
Replenished
08/18/2023
1002260285
3143898442
False
10033523
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799404
MR00014956
00
07/27/2023
07/27/2023
07/28/2023
55111064501
OMEPRAZOLE DR 40 MG CAPSULE
40 MG
CAPSULE DR
100
60
20
33.33300
Replenished
08/18/2023
1002260285
3143898442
False
10028377
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000799404
MR00014956
00
07/27/2023
07/27/2023
07/28/2023
55111064501
OMEPRAZOLE DR 40 MG CAPSULE
40 MG
CAPSULE DR
100
60
40
66.66700
Replenished
08/22/2023
1002251495
3141657237
False
9972247
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797998
MR00392530
02
07/19/2023
07/19/2023
07/20/2023
55111064501
OMEPRAZOLE DR 40 MG CAPSULE
40 MG
CAPSULE DR
100
30
30
100.00000
Replenished
08/22/2023
1002251495
3141657237
False
9955048
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797330
MR00174136
03
07/14/2023
07/15/2023
07/16/2023
55111064501
OMEPRAZOLE DR 40 MG CAPSULE
40 MG
CAPSULE DR
100
30
30
100.00000
Replenished
08/22/2023
1002251495
3141657237