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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
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011062 MR000760600011/16/202011/16/202011/17/202000228202910ALPRAZOLAM 0.5 MG TABLET0.5 MGTABLET100302583.33300Replenished 1001765592
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012500 MR000620750012/27/202212/27/202212/28/202200228202910ALPRAZOLAM 0.5 MG TABLET0.5 MGTABLET100120108.33300Replenished 1002154521 3117768445
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012500 MR000620750012/27/202212/27/202212/28/202200228202910ALPRAZOLAM 0.5 MG TABLET0.5 MGTABLET100120108.33400Replenished 1002160851 3118886766
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012500 MR000620750012/27/202212/27/202212/28/202200228202910ALPRAZOLAM 0.5 MG TABLET0.5 MGTABLET10012010083.33300Replenished 1002154521 3117768445
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012502 MR000760600012/27/202212/27/202212/28/202200228202910ALPRAZOLAM 0.5 MG TABLET0.5 MGTABLET1009090100.00000Replenished 1002154521 3117768445
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012516 MR001540790001/05/202301/05/202301/06/202300228202910ALPRAZOLAM 0.5 MG TABLET0.5 MGTABLET1006060100.00000Replenished 1002164575 3120074503
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012517 MR003891700001/05/202301/05/202301/06/202300228202910ALPRAZOLAM 0.5 MG TABLET0.5 MGTABLET1001051514.28600Replenished 1002164575 3120074503
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012517 MR003891700001/05/202301/05/202301/06/202300228202910ALPRAZOLAM 0.5 MG TABLET0.5 MGTABLET1001059085.71400Replenished 1002160851 3118886766
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012529 MR000929910001/16/202301/16/202301/17/202300228202910ALPRAZOLAM 0.5 MG TABLET0.5 MGTABLET100135107.40700Replenished 1002167937 3121218015
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012529 MR000929910001/16/202301/16/202301/17/202300228202910ALPRAZOLAM 0.5 MG TABLET0.5 MGTABLET1001352518.51900Replenished 1002164575 3120074503