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	5117227		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000786683	MR00296590	00	12/03/2021	12/06/2021	12/07/2021	33342032980	TRIAMCINOLONE 0.1% CREAM	0.1 %	CREAM(GM)	80	80	80	100.00000	Replenished		1001969736	3076071583
False	7228441		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000786683	MR00296590	01	08/30/2022	08/30/2022	09/01/2022	33342032980	TRIAMCINOLONE 0.1% CREAM	0.1 %	CREAM(GM)	80	80	80	100.00000	Replenished		1002099459	3104747366
False	7286282		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000792785	MR00005078	00	09/08/2022	09/08/2022	09/10/2022	33342032980	TRIAMCINOLONE 0.1% CREAM	0.1 %	CREAM(GM)	80	80	80	100.00000	Replenished		1002102488	3105614645