| Contract Pharmacy
Accumulator - View By Claim
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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
9263850
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Cash 340B
000000797704
MR00240690
00
05/02/2023
05/02/2023
05/02/2023
00046110181
PREMARIN 0.45 MG TABLET
0.45MG
TABLET
100
100
30
30.00000
Replenished
08/22/2023
1002248399
3140374263
False
9249499
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Cash 340B
000000797704
MR00240690
00
05/02/2023
05/02/2023
05/02/2023
00046110181
PREMARIN 0.45 MG TABLET
0.45MG
TABLET
100
100
70
70.00000
Replenished
05/04/2023
1002213073
3132184003
False
6505395
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790790
MR00086036
00
06/09/2022
06/09/2022
06/10/2022
00046110181
PREMARIN 0.45 MG TABLET
0.45MG
TABLET
100
30
30
100.00000
Replenished
1002107636
3106060757
False
6863255
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790790
MR00086036
01
07/12/2022
07/12/2022
07/13/2022
00046110181
PREMARIN 0.45 MG TABLET
0.45MG
TABLET
100
30
30
100.00000
Replenished
1002107636
3106060757
False
7100669
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000790790
MR00086036
02
08/13/2022
08/13/2022
08/14/2022
00046110181
PREMARIN 0.45 MG TABLET
0.45MG
TABLET
100
30
30
100.00000
Replenished
1002107636
3106060757
False
7317856
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792831
MR00086036
00
09/12/2022
09/12/2022
09/13/2022
00046110181
PREMARIN 0.45 MG TABLET
0.45MG
TABLET
100
30
10
33.33300
Replenished
1002107636
3106060757
False
7325230
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792831
MR00086036
00
09/12/2022
09/12/2022
09/13/2022
00046110181
PREMARIN 0.45 MG TABLET
0.45MG
TABLET
100
30
20
66.66700
Replenished
1002143287
3115100157
False
7486240
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792831
MR00086036
01
10/05/2022
10/05/2022
10/06/2022
00046110181
PREMARIN 0.45 MG TABLET
0.45MG
TABLET
100
30
30
100.00000
Replenished
1002143287
3115100157
False
7761424
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000792831
MR00086036
02
11/08/2022
11/08/2022
11/09/2022
00046110181
PREMARIN 0.45 MG TABLET
0.45MG
TABLET
100
30
30
100.00000
Replenished
1002143287
3115100157
False
7982511
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000794643
MR00086036
00
12/05/2022
12/05/2022
12/06/2022
00046110181
PREMARIN 0.45 MG TABLET
0.45MG
TABLET
100
30
10
33.33300
Replenished
1002186410
3126119732