| Contract Pharmacy
Accumulator - View By Claim
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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
True
2934280
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
13668001101
CITALOPRAM HBR 40 MG TABLET
40 MG
TABLET
100
0
40
0.00000
Suspended
1001790379
True
2933516
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
27241012403
SILDENAFIL 20 MG TABLET
20 MG
TABLET
90
0
20
0.00000
Suspended
1001711128
True
2933514
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
31722064430
TADALAFIL 5 MG TABLET
5 MG
TABLET
30
0
30
0.00000
Suspended
1001735909
True
2933562
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
43547027503
DONEPEZIL HCL 5 MG TABLET
5 MG
TABLET
30
0
30
0.00000
Suspended
1001001730
True
3952867
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
43547027503
DONEPEZIL HCL 5 MG TABLET
5 MG
TABLET
30
0
30
0.00000
Suspended
1001205652
True
2933623
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
50111033401
METRONIDAZOLE 500 MG TABLET
500 MG
TABLET
100
0
24
0.00000
Suspended
1001079172
True
2933600
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
55111034101
AMLODIPINE-BENAZEPRIL 10-20 MG
10 MG-20MG
CAPSULE
100
0
70
0.00000
Suspended
1000882343
True
2933596
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
55513071001
PROLIA 60 MG/ML SYRINGE
60 MG/ML
DISP SYRIN
1
0
1
0.00000
Suspended
1001483941
True
2933542
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
57237010001
METOPROLOL TARTRATE 25 MG TAB
25 MG
TABLET
100
0
50
0.00000
Suspended
1001653069
True
2934505
Memorial Hospital
**Trapp Pharmacy (#1)
**Trapp Pharmacy (#1)
59746021601
SPIRONOLACTONE 25 MG TABLET
25 MG
TABLET
100
0
45
0.00000
Suspended
1001782104