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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 000000778745 MR003894840012/22/202012/22/202012/23/202059746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET100604575.00000Replenished 1001782104
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793116 MR001954630009/27/202209/27/202209/28/202259746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET100301033.33300Replenished 1001782104
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000772437 MR000952171103/08/202103/08/202103/09/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001824202 3049524740
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778385 MR002880260103/09/202103/09/202103/10/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET100903538.88900Replenished 1001824202 3049524740
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778745 MR003894840102/19/202102/19/202102/20/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET100603558.33300Replenished 1001824202 3049524740
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778385 MR002880260103/09/202103/09/202103/10/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET100905561.11100Replenished 1001849254 3054056168
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778745 MR003894840204/26/202104/26/202104/27/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET100601525.00000Replenished 1001849254 3054056168
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780909 MR000952170003/31/202103/31/202104/01/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001849254 3054056168
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778745 MR003894840204/26/202104/26/202104/27/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET100604575.00000Replenished 1001867724 3057523425
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780909 MR000952170105/04/202105/04/202105/05/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001867724 3057523425