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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 000000778196 MR002142010012/01/202012/01/202012/03/202059746017306PREDNISONE 10 MG TABLET10 MGTABLET100482450.00000Replenished 1001773574
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778196 MR002142010012/01/202012/01/202012/03/202059746017306PREDNISONE 10 MG TABLET10 MGTABLET100482450.00000Replenished 1001916855 3066262939
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781472 MR002183130004/26/202104/26/202104/27/202159746017306PREDNISONE 10 MG TABLET10 MGTABLET10044100.00000Replenished 1001916855 3066262939
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782944 MR000649240006/28/202106/28/202106/29/202159746017306PREDNISONE 10 MG TABLET10 MGTABLET1003030100.00000Replenished 1001916855 3066262939
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782944 MR000649240107/24/202107/24/202107/25/202159746017306PREDNISONE 10 MG TABLET10 MGTABLET1003030100.00000Replenished 1001916855 3066262939
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784421 MR000649240008/30/202108/30/202108/31/202159746017306PREDNISONE 10 MG TABLET10 MGTABLET100301240.00000Replenished 1001916855 3066262939
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784421 MR000649240008/30/202108/30/202108/31/202159746017306PREDNISONE 10 MG TABLET10 MGTABLET100301860.00000Replenished 1001963534 3074872858
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785103 MR000649240009/27/202109/27/202109/28/202159746017306PREDNISONE 10 MG TABLET10 MGTABLET1003030100.00000Replenished 1001963534 3074872858
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785765 MR000649240010/25/202110/25/202110/26/202159746017306PREDNISONE 10 MG TABLET10 MGTABLET1003030100.00000Replenished 1001963534 3074872858
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786453 MR000649240011/23/202111/23/202111/24/202159746017306PREDNISONE 10 MG TABLET10 MGTABLET10030826.66700Replenished 1002008101 3084006370