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	2933805		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779102	MR00288026	00	01/11/2021	01/14/2021	01/15/2021	76204020025	ALBUTEROL SUL 2.5 MG/3 ML SOLN	2.5 MG/3ML	VIAL-NEB.	75	360	60	16.66700	Replenished		1001851763	3054766187
False	2933804		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779102	MR00288026	00	01/11/2021	01/14/2021	01/15/2021	76204020025	ALBUTEROL SUL 2.5 MG/3 ML SOLN	2.5 MG/3ML	VIAL-NEB.	75	360	75	20.83300	Replenished		1001796904
False	2933806		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779102	MR00288026	00	01/11/2021	01/14/2021	01/15/2021	76204020025	ALBUTEROL SUL 2.5 MG/3 ML SOLN	2.5 MG/3ML	VIAL-NEB.	75	360	75	20.83300	Replenished		1001796904
False	2933807		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779102	MR00288026	00	01/11/2021	01/14/2021	01/15/2021	76204020025	ALBUTEROL SUL 2.5 MG/3 ML SOLN	2.5 MG/3ML	VIAL-NEB.	75	360	75	20.83300	Replenished		1001796904
False	2933808		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000779102	MR00288026	00	01/11/2021	01/14/2021	01/15/2021	76204020025	ALBUTEROL SUL 2.5 MG/3 ML SOLN	2.5 MG/3ML	VIAL-NEB.	75	360	75	20.83400	Replenished		1001796904
False	3470758		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000781638	5509	00	05/03/2021	05/03/2021	05/04/2021	76204020025	ALBUTEROL SUL 2.5 MG/3 ML SOLN	2.5 MG/3ML	VIAL-NEB.	75	75	15	20.00000	Replenished		1001851763	3054766187
False	3474215		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000781638	5509	00	05/03/2021	05/03/2021	05/04/2021	76204020025	ALBUTEROL SUL 2.5 MG/3 ML SOLN	2.5 MG/3ML	VIAL-NEB.	75	75	60	80.00000	Replenished		1001929791	3069291945
False	4623375		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000785171	MR00288026	00	09/29/2021	09/29/2021	09/30/2021	76204020025	ALBUTEROL SUL 2.5 MG/3 ML SOLN	2.5 MG/3ML	VIAL-NEB.	75	360	15	4.16700	Replenished		1001929791	3069291945
False	4628796		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000785171	MR00288026	00	09/29/2021	09/29/2021	09/30/2021	76204020025	ALBUTEROL SUL 2.5 MG/3 ML SOLN	2.5 MG/3ML	VIAL-NEB.	75	360	45	12.50100	Replenished		1001937905	3070173196
False	4628792		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000785171	MR00288026	00	09/29/2021	09/29/2021	09/30/2021	76204020025	ALBUTEROL SUL 2.5 MG/3 ML SOLN	2.5 MG/3ML	VIAL-NEB.	75	360	75	20.83300	Replenished		1001929791	3069291945