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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 000000779485 MR000186701112/27/202112/27/202112/28/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001980038 3078339609
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776364 MR001513541008/14/202108/14/202108/15/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001904108 3064589184
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779485 MR000186701011/24/202111/24/202111/25/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001963864 3074997377
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776364 MR001513540907/16/202107/16/202107/17/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001890605 3061781567
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779485 MR000186700910/28/202110/28/202110/29/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001951026 3072312986
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776364 MR001513540806/18/202106/18/202106/19/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001876579 3059092930
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779485 MR000186700809/27/202109/27/202109/28/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001928804 3069023028
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776364 MR001513540705/14/202105/14/202105/15/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001859387 3055792361
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779485 MR000186700708/26/202108/26/202108/27/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001911378 3066004376
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776364 MR001513540604/13/202104/13/202104/14/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001842802 3052853627