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
True	2933618		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)								60432062116	VALPROIC ACID 250 MG/5 ML SOLN	250 MG/5ML	SOLUTION	473	0	473	0.00000	Suspended		1000934136
True	2933544		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)								68001011707	LEVETIRACETAM 500 MG TABLET	500 MG	TABLET	120	0	120	0.00000	Suspended		1001602316
True	2933640		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)								00228277911	PROPRANOLOL ER 80 MG CAPSULE	80 MG	CAP.SA 24H	100	0	100	0.00000	Suspended		1001335840
True	5502663		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)								16571065710	CEVIMELINE HCL 30 MG CAPSULE	30 MG	CAPSULE	100	0	100	0.00000	Suspended		1001965736	3075594883
True	2933612		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)								60505018300	CARBAMAZEPINE 200 MG TABLET	200 MG	TABLET	100	0	100	0.00000	Suspended		1001287036
True	2933611		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)								60505018300	CARBAMAZEPINE 200 MG TABLET	200 MG	TABLET	100	0	100	0.00000	Suspended		1001308866
True	2933610		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)								60505018300	CARBAMAZEPINE 200 MG TABLET	200 MG	TABLET	100	0	100	0.00000	Suspended		1001316498
True	2933555		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)								60505313001	QUETIAPINE FUMARATE 25 MG TAB	25 MG	TABLET	100	0	100	0.00000	Suspended		1000970964
True	2933554		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)								60505313001	QUETIAPINE FUMARATE 25 MG TAB	25 MG	TABLET	100	0	100	0.00000	Suspended		1001020386
True	2933553		Memorial Hospital	**Trapp Pharmacy (#1)	**Trapp Pharmacy (#1)								60505313001	QUETIAPINE FUMARATE 25 MG TAB	25 MG	TABLET	100	0	100	0.00000	Suspended		1001067246