| Contract Pharmacy
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
3048369
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000772905
MR00340166
11
03/05/2021
03/05/2021
03/06/2021
68180046409
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
30
30
100.00000
Replenished
1001822785
3049139689
False
3247533
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000772905
MR00340166
12
04/02/2021
04/02/2021
04/03/2021
68180046409
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
30
30
100.00000
Replenished
1001843344
3052979164
False
2978588
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000774397
MR00248646
02
02/22/2021
02/22/2021
02/23/2021
68180046409
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
90
30
33.33300
Replenished
1001819373
988099025
False
2976625
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000774397
MR00248646
02
02/22/2021
02/22/2021
02/23/2021
68180046409
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
90
60
66.66700
Replenished
1001816056
987916714
False
3573818
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000774397
MR00248646
03
05/15/2021
05/15/2021
05/16/2021
68180046409
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
90
30
33.33300
Replenished
1001874393
3058663336
False
3569181
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000774397
MR00248646
03
05/15/2021
05/15/2021
05/16/2021
68180046409
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
90
60
66.66700
Replenished
1001859763
3055792362
False
3456027
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000775526
MR00174136
03
04/30/2021
04/30/2021
05/01/2021
68180046409
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
90
90
100.00000
Replenished
1001850989
3054468652
False
4147198
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000775526
MR00174136
04
07/28/2021
07/28/2021
07/29/2021
68180046409
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
90
30
33.33300
Replenished
1001897770
3062993331
False
4153966
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000775526
MR00174136
04
07/28/2021
07/28/2021
07/29/2021
68180046409
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
90
60
66.66700
Replenished
1001899045
3063437222
False
3580471
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000000775563
MR00161147
03
05/17/2021
05/17/2021
05/18/2021
68180046409
SIMVASTATIN 40 MG TABLET
40 MG
TABLET
90
90
30
33.33300
Replenished
1001883113
3060162693