View By Claim - BAR

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Accumulator - View By Claim

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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	10033526		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796190	MR00158455	06	07/27/2023	07/27/2023	07/28/2023	62332014231	CELECOXIB 200 MG CAPSULE	200 MG	CAPSULE	100	30	4	13.33300	Replenished	08/22/2023	1002251766	3141657239
False	10028389		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)	Third Party – Captured	000000796190	MR00158455	06	07/27/2023	07/27/2023	07/28/2023	62332014231	CELECOXIB 200 MG CAPSULE	200 MG	CAPSULE	100	30	26	86.66700	Replenished	08/22/2023	1002251495	3141657237