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	2967711		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780036	1882	00	02/19/2021	02/19/2021	02/20/2021	68462029855	CLOTRIMAZOLE-BETAMETHASONE CRM	1 %-0.05 %	CREAM(GM)	45	45	45	100.00000	Replenished		1001814818	987756777
False	2976600		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780085	MR00062075	00	02/22/2021	02/22/2021	02/23/2021	68462029855	CLOTRIMAZOLE-BETAMETHASONE CRM	1 %-0.05 %	CREAM(GM)	45	45	45	100.00000	Replenished		1001816056	987916714
False	3080820		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000780449	4516	00	03/12/2021	03/12/2021	03/13/2021	68462029855	CLOTRIMAZOLE-BETAMETHASONE CRM	1 %-0.05 %	CREAM(GM)	45	45	45	100.00000	Replenished		1001825961	3049810904
False	3760373		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000782656	MR00169717	00	06/14/2021	06/14/2021	06/15/2021	68462029855	CLOTRIMAZOLE-BETAMETHASONE CRM	1 %-0.05 %	CREAM(GM)	45	45	45	100.00000	Replenished		1001874393	3058663336
False	4352950		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784264	1882	00	08/24/2021	08/24/2021	08/25/2021	68462029855	CLOTRIMAZOLE-BETAMETHASONE CRM	1 %-0.05 %	CREAM(GM)	45	45	45	100.00000	Replenished		1001908531	3065691570
False	4842292		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000785881	MR00327536	00	10/29/2021	10/29/2021	10/30/2021	68462029855	CLOTRIMAZOLE-BETAMETHASONE CRM	1 %-0.05 %	CREAM(GM)	45	45	45	100.00000	Replenished		1001951026	3072312986