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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)Cash 340B 000000780340 MR003774780003/05/202103/05/202103/05/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60601016.66700Replenished 1001822785 3049139689
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000781533 MR003774780004/27/202104/27/202104/27/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60601016.66700Replenished 1001849752 3054181639
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000782918 MR003774780006/28/202106/28/202106/28/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60601016.66700Replenished 1001882607 3060033992
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000783250 B6EECJ3SDDFQ0007/12/202107/12/202107/12/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60601016.66700Replenished 1001889250 3061354275
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000783998 B6EECJ3SDDFQ0008/12/202108/12/202108/12/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60301033.33300Replenished 1001903497 3064589180
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774754 MR000606040602/19/202102/19/202102/20/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60601016.66700Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774754 MR000606040703/23/202103/23/202103/25/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60601016.66700Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774754 MR000606040804/22/202104/22/202104/23/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60601016.66700Replenished 1001847629 3053810031
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774754 MR000606040905/24/202105/24/202105/25/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60601016.66700Replenished 1001863873 3056827847
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774754 MR000606041006/21/202106/21/202106/22/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60601016.66700Replenished 1001877828 3059333148