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	10171654		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000792892	MR00240898	08	08/16/2023	08/16/2023	08/17/2023	68180096301	ALBUTEROL HFA 90 MCG INHALER	90 MCG	HFA AER AD	8.5	8.5	8.5	100.00000	Replenished	08/18/2023	1002260285	3143898442
False	10110419		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796197	MR00210929	05	08/09/2023	08/09/2023	08/10/2023	68180096301	ALBUTEROL HFA 90 MCG INHALER	90 MCG	HFA AER AD	8.5	8.5	8.5	100.00000	Replenished	08/11/2023	1002254446	3143082008
False	10036280		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000793472	MR00067064	01	07/28/2023	07/28/2023	07/29/2023	68180096301	ALBUTEROL HFA 90 MCG INHALER	90 MCG	HFA AER AD	8.5	8.5	8.5	100.00000	Replenished	08/22/2023	1002251766	3141657239
False	10028401		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799403	MR00108206	00	07/27/2023	07/27/2023	07/28/2023	68180096301	ALBUTEROL HFA 90 MCG INHALER	90 MCG	HFA AER AD	8.5	8.5	8.5	100.00000	Replenished	08/22/2023	1002251495	3141657237
False	10028371		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000799414	MR00389118	00	07/27/2023	07/27/2023	07/28/2023	68180096301	ALBUTEROL HFA 90 MCG INHALER	90 MCG	HFA AER AD	8.5	8.5	8.5	100.00000	Replenished	08/22/2023	1002251495	3141657237
False	9962809		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000792892	MR00240898	07	07/18/2023	07/18/2023	07/19/2023	68180096301	ALBUTEROL HFA 90 MCG INHALER	90 MCG	HFA AER AD	8.5	8.5	8.5	100.00000	Replenished	08/22/2023	1002248589	3140519199
False	9962821		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796197	MR00210929	04	07/18/2023	07/18/2023	07/19/2023	68180096301	ALBUTEROL HFA 90 MCG INHALER	90 MCG	HFA AER AD	8.5	8.5	8.5	100.00000	Replenished	08/22/2023	1002248589	3140519199
False	8807377		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000789271	MR00389118	03	03/09/2023	03/09/2023	03/10/2023	68180096301	ALBUTEROL HFA 90 MCG INHALER	90 MCG	HFA AER AD	8.5	8.5	8.5	100.00000	Replenished		1002187584	3126302342
False	8765251		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796518	MR00171522	00	03/06/2023	03/06/2023	03/07/2023	68180096301	ALBUTEROL HFA 90 MCG INHALER	90 MCG	HFA AER AD	8.5	8.5	8.5	100.00000	Replenished		1002185583	3125815325
False	8669234		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796326	MR00395619	00	02/24/2023	02/24/2023	02/25/2023	68180096301	ALBUTEROL HFA 90 MCG INHALER	90 MCG	HFA AER AD	8.5	8.5	8.5	100.00000	Replenished		1002182751	3124681385