Claim Details
Smith, Mary
POST
08/29/2014
9458594
New
30
8/29/2014
40
YES
YES
455789635
21547898
2.0
254
10425478
12/8/2014
Blue Cross
BHL0798
BHL0798
Section for Comment
Configuration
| Claim ID | Rx# | Status | Fill Date | Proc. Date | Drug Name | Mbr Cost | Pharmacy Name | Discount |
|---|---|---|---|---|---|---|---|---|
| 4492994005 | 2959697 | DENIED | 12/17/2014 | 12/17/2014 14:50:44 | TIMOLOL 0.5% EYE DROPS | $0.00 | TROPICANA DRUGS | Yes |
| 4492994005 | 2959697 | Reversed | 12/17/2014 | 12/17/2014 14:50:44 | TIMOLOL 0.5% EYE DROPS | $0.00 | TROPICANA DRUGS | No |
| 4492994005 | 2959697 | DENIED | 12/17/2014 | 12/17/2014 14:50:44 | TIMOLOL 0.5% EYE DROPS | $0.00 | TROPICANA DRUGS | Yes |
| 4492994005 | 2959697 | Reversed | 12/17/2014 | 12/17/2014 14:50:44 | TIMOLOL 0.5% EYE DROPS | $0.00 | TROPICANA DRUGS | No |
| Claim ID | Rx# | Status | Fill Date | Proc. Date | Drug Name | Mbr Cost | Pharmacy Name | Discount |
|---|---|---|---|---|---|---|---|---|
| 4492994005 | 2959697 | DENIED | 12/17/2014 | 12/17/2014 14:50:44 | TIMOLOL 0.5% EYE DROPS | $0.00 | TROPICANA DRUGS | Yes |
| 4492994005 | 2959697 | Reversed | 12/17/2014 | 12/17/2014 14:50:44 | TIMOLOL 0.5% EYE DROPS | $0.00 | TROPICANA DRUGS | No |
| 4492994005 | 2959697 | DENIED | 12/17/2014 | 12/17/2014 14:50:44 | TIMOLOL 0.5% EYE DROPS | $0.00 | TROPICANA DRUGS | Yes |
| 4492994005 | 2959697 | Reversed | 12/17/2014 | 12/17/2014 14:50:44 | TIMOLOL 0.5% EYE DROPS | $0.00 | TROPICANA DRUGS | No |