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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 000000774556 MR002420681106/01/202106/01/202106/02/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1003030100.00000Replenished 1001867724 3057523425
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775750 MR001825341107/12/202107/12/202107/13/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1006060100.00000Replenished 1001889250 3061354275
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778020 MR002640321110/21/202110/21/202110/22/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1003030100.00000Replenished 1001946740 3071601882
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778438 MR002028491111/01/202111/01/202111/02/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR10030620.00000Replenished 1001952427 3072856896
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778438 MR002028491111/01/202111/01/202111/02/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100302480.00000Replenished 1001951777 3072578295
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782276 MR002798371105/07/202205/07/202205/08/202268462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1003030100.00000Replenished 1002050106 3092568972
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783009 MR002420681105/31/202205/31/202206/01/202268462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1003030100.00000Replenished 1002059808 3094872674
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786349 MR002640321110/17/202210/17/202210/18/202268462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR10030620.00000Replenished 1002123446 3109811595
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786349 MR002640321110/17/202210/17/202210/18/202268462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100302480.00000Replenished 1002123772 3109960845
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790105 MR001613011103/30/202303/30/202303/31/202368462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1003030100.00000Replenished 1002197595 3128646478