| 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
3238019
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011305
MR00092991
01
04/01/2021
04/01/2021
04/02/2021
51991070501
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
25
20.83300
Replenished
1001836082
3051817900
False
3245072
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011305
MR00092991
01
04/01/2021
04/01/2021
04/02/2021
51991070501
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
95
79.16700
Replenished
1001843344
3052979163
False
3438518
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011305
MR00092991
02
04/27/2021
04/27/2021
04/28/2021
51991070501
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
5
4.16700
Replenished
1001855254
3055135220
False
3438517
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011305
MR00092991
02
04/27/2021
04/27/2021
04/28/2021
51991070501
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
15
12.50000
Replenished
1001849752
3054181638
False
3433661
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011305
MR00092991
02
04/27/2021
04/27/2021
04/28/2021
51991070501
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
100
83.33300
Replenished
1001849752
3054181638
False
3653114
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011305
MR00092991
03
05/27/2021
05/27/2021
05/28/2021
51991070501
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
45
37.50000
Replenished
1001866451
3057164797
False
3647957
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011305
MR00092991
03
05/27/2021
05/27/2021
05/28/2021
51991070501
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
75
62.50000
Replenished
1001865893
3057164795
False
3136399
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011335
MR00154079
00
03/18/2021
03/18/2021
03/19/2021
51991070501
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
60
60
100.00000
Replenished
1001831820
3050993426
False
3166426
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011344
MR00062075
00
03/23/2021
03/23/2021
03/25/2021
51991070501
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
40
33.33300
Replenished
1001831820
3050993426
False
3171385
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004011344
MR00062075
00
03/23/2021
03/23/2021
03/25/2021
51991070501
ALPRAZOLAM 0.5 MG TABLET
0.5 MG
TABLET
100
120
80
66.66700
Replenished
1001835056
3051528183