| 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
3678019
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782379
MR00402566
00
06/02/2021
06/02/2021
06/03/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1001876050
3059092759
False
9035372
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797124
MR00368660
00
04/05/2023
04/05/2023
04/06/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1002199797
3129427834
False
9375349
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000797910
MR00368660
00
05/12/2023
05/12/2023
05/16/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
05/24/2023
1002222847
3134351839
False
9787443
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798772
MR00368660
00
06/26/2023
06/26/2023
06/27/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
9
30.00000
Replenished
06/28/2023
1002238348
3138156842
False
9790075
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000798772
MR00368660
00
06/26/2023
06/26/2023
06/27/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
21
70.00000
Replenished
06/30/2023
1002238934
3138442989
False
8514195
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795959
MR00308211
00
02/07/2023
02/07/2023
02/08/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
30
100.00000
Replenished
1002178976
3123538684
False
8737573
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795959
MR00308211
01
03/02/2023
03/02/2023
03/03/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
1
3.33300
Replenished
1002193992
3127402543
False
8728036
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795959
MR00308211
01
03/02/2023
03/02/2023
03/03/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
29
96.66700
Replenished
1002184466
3125496601
False
9187786
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795959
MR00308211
02
04/21/2023
04/21/2023
04/22/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
1
3.33400
Replenished
05/08/2023
1002213772
3132524754
False
9187785
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000795959
MR00308211
02
04/21/2023
04/21/2023
04/22/2023
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
10
33.33300
Replenished
04/24/2023
1002209778
3130976966