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	4276909		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000784033	MR00038013	00	08/14/2021	08/14/2021	08/15/2021	45802005536	TRIAMCINOLONE 0.1% OINTMENT	0.1 %	OINT.(GM)	80	80	80	100.00000	Replenished		1001904108	3064589184
False	5709510		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000788509	MR00038013	00	02/23/2022	02/23/2022	02/24/2022	45802005536	TRIAMCINOLONE 0.1% OINTMENT	0.1 %	OINT.(GM)	80	80	80	100.00000	Replenished		1002010793	3084577185