| 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
7187606
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012090
MR00030919
05
08/23/2022
08/23/2022
08/25/2022
00378047701
DIAZEPAM 10 MG TABLET
10 MG
TABLET
100
30
1
3.33300
Replenished
1002152667
3117383034
False
6283296
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012163
MR00050302
00
05/10/2022
05/10/2022
05/11/2022
00378047701
DIAZEPAM 10 MG TABLET
10 MG
TABLET
100
1
1
100.00000
Replenished
1002053268
3093648507
False
7366032
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012360
MR00182534
00
09/19/2022
09/19/2022
09/20/2022
00378047701
DIAZEPAM 10 MG TABLET
10 MG
TABLET
100
1
1
100.00000
Replenished
1002152667
3117383034
False
7636457
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012405
MR00182534
00
10/24/2022
10/24/2022
10/25/2022
00378047701
DIAZEPAM 10 MG TABLET
10 MG
TABLET
100
1
1
100.00000
Replenished
1002152667
3117383034
False
8065968
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012477
MR00184790
00
12/14/2022
12/14/2022
12/15/2022
00378047701
DIAZEPAM 10 MG TABLET
10 MG
TABLET
100
1
1
100.00000
Replenished
1002152667
3117383034
False
7609161
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012398
MR00029476
00
10/20/2022
10/20/2022
10/21/2022
00378047701
DIAZEPAM 10 MG TABLET
10 MG
TABLET
100
2
2
100.00000
Replenished
1002152667
3117383034
False
8139088
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012373
MR00030919
03
12/23/2022
12/23/2022
12/24/2022
00378047701
DIAZEPAM 10 MG TABLET
10 MG
TABLET
100
30
4
13.33300
Replenished
1002152667
3117383034
False
5655145
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012034
MR00030919
00
02/15/2022
02/15/2022
02/16/2022
00378047701
DIAZEPAM 10 MG TABLET
10 MG
TABLET
100
30
10
33.33300
Replenished
1002007313
3084006128
False
6349333
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012090
MR00030919
02
05/18/2022
05/18/2022
05/19/2022
00378047701
DIAZEPAM 10 MG TABLET
10 MG
TABLET
100
30
11
36.66700
Replenished
1002096808
3104187392
False
8945434
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
Third Party – Captured
000004012620
MR00030919
00
03/27/2023
03/27/2023
03/28/2023
00378047701
DIAZEPAM 10 MG TABLET
10 MG
TABLET
100
30
14
46.66700
Replenished
1002195747
3128183149