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	10110435		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000795883	MR00230427	02	08/09/2023	08/09/2023	08/10/2023	68382077316	EZETIMIBE 10 MG TABLET	10 MG	TABLET	90	90	90	100.00000	Replenished	08/11/2023	1002254446	3143082008
False	10180326		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799795	MR00194370	00	08/17/2023	08/17/2023	08/18/2023	68382077316	EZETIMIBE 10 MG TABLET	10 MG	TABLET	90	90	90	100.00000	Replenished	08/21/2023	1002260563	3144082982