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	6404542		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790525	MR00195463	00	05/26/2022	05/26/2022	05/27/2022	16729022501	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	30	30	100.00000	Replenished		1002063533	3095507522
False	6429622		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790588	MR00389484	00	05/31/2022	05/31/2022	06/01/2022	16729022501	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	60	60	100.00000	Replenished		1002063533	3095507522
False	6472567		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790723	MR00237205	00	06/06/2022	06/06/2022	06/07/2022	16729022501	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	30	10	33.33300	Replenished		1002063533	3095507522
False	6480430		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790723	MR00237205	00	06/06/2022	06/06/2022	06/07/2022	16729022501	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	30	20	66.66700	Replenished		1002084916	3100895806
False	6966729		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000790723	MR00237205	01	07/26/2022	07/26/2022	07/27/2022	16729022501	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	30	30	100.00000	Replenished		1002084916	3100895806
False	6749342		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000791182	MR00195463	00	06/29/2022	06/29/2022	07/01/2022	16729022501	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	30	30	100.00000	Replenished		1002084916	3100895806
False	6987296		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000791182	MR00195463	01	07/28/2022	07/28/2022	07/29/2022	16729022501	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	30	30	100.00000	Replenished		1002094508	3103080550
False	7217474		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000791182	MR00195463	02	08/29/2022	08/29/2022	08/30/2022	16729022501	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	30	30	100.00000	Replenished		1002112616	3107562830
False	6976664		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000791786	MR00389484	00	07/27/2022	07/27/2022	07/28/2022	16729022501	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	60	20	33.33300	Replenished		1002084916	3100895806
False	6983430		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000791786	MR00389484	00	07/27/2022	07/27/2022	07/28/2022	16729022501	SPIRONOLACTONE 25 MG TABLET	25 MG	TABLET	100	60	40	66.66700	Replenished		1002094508	3103080550