| 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
3577390
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781978
MR00218418
00
05/17/2021
05/17/2021
05/18/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
10
11.11100
Replenished
1001860456
3056066373
False
3580470
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000781978
MR00218418
00
05/17/2021
05/17/2021
05/18/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
80
88.88900
Replenished
1001862702
3056474257
False
3622352
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782165
MR00072992
00
05/24/2021
05/24/2021
05/25/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
30
33.33300
Replenished
1001863873
3056827847
False
3625920
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782165
MR00072992
00
05/24/2021
05/24/2021
05/25/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
60
66.66700
Replenished
1001864958
3056990723
False
3675657
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782291
MR00035389
00
06/01/2021
06/01/2021
06/02/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
10
11.11100
Replenished
1001876050
3059092759
False
3671958
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782291
MR00035389
00
06/01/2021
06/01/2021
06/02/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
80
88.88900
Replenished
1001867724
3057523425
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
3783972
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782721
MR00034656
00
06/17/2021
06/17/2021
06/18/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
30
33.33300
Replenished
1001876050
3059092759
False
3788677
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000782721
MR00034656
00
06/17/2021
06/17/2021
06/18/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
90
60
66.66700
Replenished
1001880371
3059776595
False
4157218
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000783209
MR00148300
00
07/09/2021
07/10/2021
07/29/2021
68001033400
LISINOPRIL 10 MG TABLET
10 MG
TABLET
100
30
20
66.66700
Replenished
1001900472
3063887831