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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 000000787389 MR001624700607/27/202207/27/202207/28/202200002223680TRULICITY 3 MG/0.5 ML PEN3 MG/0.5MLPEN INJCTR222100.00000Replenished 1002084916 3100895806
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792446 MR001624700008/25/202208/25/202208/26/202200002223680TRULICITY 3 MG/0.5 ML PEN3 MG/0.5MLPEN INJCTR222100.00000Replenished 1002100079 3104971541
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792446 MR001624700109/23/202209/23/202209/24/202200002223680TRULICITY 3 MG/0.5 ML PEN3 MG/0.5MLPEN INJCTR222100.00000Replenished 1002113582 3107872087
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792446 MR001624700210/24/202210/24/202210/25/202200002223680TRULICITY 3 MG/0.5 ML PEN3 MG/0.5MLPEN INJCTR222100.00000Replenished 1002125076 3110431983
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792446 MR001624700311/23/202211/23/202211/24/202200002223680TRULICITY 3 MG/0.5 ML PEN3 MG/0.5MLPEN INJCTR222100.00000Replenished 1002139267 3113875248
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792446 MR001624700412/23/202212/23/202212/24/202200002223680TRULICITY 3 MG/0.5 ML PEN3 MG/0.5MLPEN INJCTR222100.00000Replenished 1002168499 3121399108