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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 000000778829 MR000255130012/28/202012/28/202012/29/202070710128501BACLOFEN 10 MG TABLET10 MGTABLET1009090100.00000Replenished 1001843344 3052979164
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781235 MR000938980004/14/202104/14/202104/15/202170710128501BACLOFEN 10 MG TABLET10 MGTABLET100180105.55600Replenished 1001843344 3052979164
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781235 MR000938980004/14/202104/14/202104/15/202170710128501BACLOFEN 10 MG TABLET10 MGTABLET1001807038.88800Replenished 1001867724 3057523425
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781235 MR000938980004/14/202104/14/202104/15/202170710128501BACLOFEN 10 MG TABLET10 MGTABLET10018010055.55600Replenished 1001843344 3052979164
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782317 MR000255130006/01/202106/01/202106/02/202170710128501BACLOFEN 10 MG TABLET10 MGTABLET100903033.33300Replenished 1001867724 3057523425
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782317 MR000255130006/01/202106/01/202106/02/202170710128501BACLOFEN 10 MG TABLET10 MGTABLET100906066.66700Replenished 1001885854 3060825455
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783123 MR000938980007/06/202107/06/202107/07/202170710128501BACLOFEN 10 MG TABLET10 MGTABLET1001804022.22200Replenished 1001885854 3060825455
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783123 MR000938980007/06/202107/06/202107/07/202170710128501BACLOFEN 10 MG TABLET10 MGTABLET1001804022.22200Replenished 1001921962 3067326644
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783123 MR000938980007/06/202107/06/202107/07/202170710128501BACLOFEN 10 MG TABLET10 MGTABLET10018010055.55600Replenished 1001885854 3060825455
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784663 MR000255130009/09/202109/09/202109/10/202170710128501BACLOFEN 10 MG TABLET10 MGTABLET100903033.33300Replenished 1001936980 3069996256