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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)Cash 340B 000000777300 MR003063190203/30/202103/30/202103/30/202100054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished 1001835056 3051528184
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000777300 MR003063190306/04/202106/04/202106/04/202100054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished 1001869532 3057728431
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000777300 MR003063190408/18/202108/18/202108/18/202100054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished 1001906178 3065115185
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785737 MR003063190010/25/202110/25/202110/25/202100054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished 1001948371 3071858707
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785737 MR003063190101/05/202201/05/202201/05/202200054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished 1001985204 3079284650
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785737 MR003063190203/16/202203/16/202203/16/202200054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished 1002020152 3086903536
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785737 MR003063190305/19/202205/19/202205/19/202200054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished 1002053268 3093648508
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785737 MR003063190407/25/202207/25/202207/25/202200054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished 1002083390 3100621822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785737 MR003063190509/30/202209/30/202209/30/202200054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished 1002113582 3107872087
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000794440 MR003063190011/23/202211/23/202211/23/202200054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished 1002139267 3113875248