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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 000000780138 MR002640320002/24/202102/24/202102/25/202100054040013DESVENLAFAXINE SUCCNT ER 50 MG50 MGTAB.SR 24H303030100.00000Replenished 1001816771 988000091
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780138 MR002640320103/25/202103/25/202103/26/202100054040013DESVENLAFAXINE SUCCNT ER 50 MG50 MGTAB.SR 24H303030100.00000Replenished 1001832780 3051158401
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780138 MR002640320204/22/202104/22/202104/23/202100054040013DESVENLAFAXINE SUCCNT ER 50 MG50 MGTAB.SR 24H303030100.00000Replenished 1001847629 3053810031
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780138 MR002640320406/22/202106/22/202106/23/202100054040013DESVENLAFAXINE SUCCNT ER 50 MG50 MGTAB.SR 24H303030100.00000Replenished 1002040320 3090640343
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780138 MR002640320507/19/202107/19/202107/20/202100054040013DESVENLAFAXINE SUCCNT ER 50 MG50 MGTAB.SR 24H303030100.00000Replenished 1001918185 3066693687
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780138 MR002640320608/20/202108/20/202108/21/202100054040013DESVENLAFAXINE SUCCNT ER 50 MG50 MGTAB.SR 24H303030100.00000Replenished 1001918185 3066693687
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780138 MR002640320709/20/202109/20/202109/21/202100054040013DESVENLAFAXINE SUCCNT ER 50 MG50 MGTAB.SR 24H303030100.00000Replenished 1001925175 3068316933
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780138 MR002640320810/21/202110/21/202110/22/202100054040013DESVENLAFAXINE SUCCNT ER 50 MG50 MGTAB.SR 24H303030100.00000Replenished 1001946740 3071601882
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780138 MR002640320911/19/202111/19/202111/20/202100054040013DESVENLAFAXINE SUCCNT ER 50 MG50 MGTAB.SR 24H303030100.00000Replenished 1001962506 3074468510
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780138 MR002640321012/20/202112/20/202112/21/202100054040013DESVENLAFAXINE SUCCNT ER 50 MG50 MGTAB.SR 24H303030100.00000Replenished 1001976721 3077692823