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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 000000774641 MR000790050304/29/202104/29/202104/30/202143598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33300Replenished 1001850989 3054468652
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774641 MR000790050304/29/202104/29/202104/30/202143598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33300Replenished 1001850989 3054468652
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774641 MR000790050304/29/202104/29/202104/30/202143598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33400Replenished 1001850989 3054468652
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779904 MR001555010002/15/202102/15/202102/16/202143598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33300Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779904 MR001555010002/15/202102/15/202102/16/202143598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33300Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779904 MR001555010002/15/202102/15/202102/16/202143598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33400Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782013 MR001555010005/18/202105/18/202105/19/202143598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33300Replenished 1001860966 3056169530
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782013 MR001555010005/18/202105/18/202105/19/202143598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33300Replenished 1001860966 3056169530
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782013 MR001555010005/18/202105/18/202105/19/202143598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33400Replenished 1001860966 3056169530
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783622 MR000790050007/28/202107/28/202107/29/202143598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33300Replenished 1001897770 3062993331