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	7463151		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793179	MR00092991	00	10/01/2022	10/01/2022	10/02/2022	62559038001	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	180	80	44.44400	Replenished		1002160525	3118886765
False	7458159		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793179	MR00092991	00	10/01/2022	10/01/2022	10/02/2022	62559038001	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	180	100	55.55600	Replenished		1002113842	3107880833
False	8231166		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000795230	MR00092991	00	01/04/2023	01/04/2023	01/05/2023	62559038001	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	180	20	11.11100	Replenished		1002160525	3118886765
False	8237864		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000795230	MR00092991	00	01/04/2023	01/04/2023	01/05/2023	62559038001	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	180	60	33.33300	Replenished		1002199438	3129427833
False	8237863		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000795230	MR00092991	00	01/04/2023	01/04/2023	01/05/2023	62559038001	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	180	100	55.55600	Replenished		1002160525	3118886765
False	9051449		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797155	MR00092991	00	04/06/2023	04/06/2023	04/07/2023	62559038001	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	180	40	22.22200	Replenished		1002199438	3129427833
False	9059609		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797155	MR00092991	00	04/06/2023	04/06/2023	04/07/2023	62559038001	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	180	40	22.22200	Replenished	08/22/2023	1002244869	3139279459
False	9059608		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000797155	MR00092991	00	04/06/2023	04/06/2023	04/07/2023	62559038001	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	180	100	55.55600	Replenished		1002199438	3129427833
False	9873261		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799002	MR00092991	00	07/06/2023	07/06/2023	07/07/2023	62559038001	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	180	60	33.33300	Replenished	08/22/2023	1002244869	3139279459
False	9880172		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799002	MR00092991	00	07/06/2023	07/06/2023	07/07/2023	62559038001	FLECAINIDE ACETATE 50 MG TAB	50 MG	TABLET	100	180	100	55.55600	Replenished	08/22/2023	1002244869	3139279459