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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 000000775156 MR000443660201/29/202101/29/202101/30/202160505257909ATORVASTATIN 20 MG TABLET20 MGTABLET909066.66700Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775156 MR000443660201/29/202101/29/202101/30/202160505257909ATORVASTATIN 20 MG TABLET20 MGTABLET90908493.33300Replenished 1001803996
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775407 MR000510590204/29/202104/29/202104/30/202160505257909ATORVASTATIN 20 MG TABLET20 MGTABLET90902123.33300Replenished 1001850687 3054468650
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775407 MR000510590204/29/202104/29/202104/30/202160505257909ATORVASTATIN 20 MG TABLET20 MGTABLET90906976.66700Replenished 1001850989 3054468652
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775407 MR000510590308/02/202108/02/202108/03/202160505257909ATORVASTATIN 20 MG TABLET20 MGTABLET90903640.00000Replenished 1001903117 3064415063
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775407 MR000510590308/02/202108/02/202108/03/202160505257909ATORVASTATIN 20 MG TABLET20 MGTABLET90905460.00000Replenished 1001901005 3064004218
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776056 MR001892720203/08/202103/08/202103/09/202160505257909ATORVASTATIN 20 MG TABLET20 MGTABLET909066.66700Replenished 1001827193 3050193216
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776056 MR001892720203/08/202103/08/202103/09/202160505257909ATORVASTATIN 20 MG TABLET20 MGTABLET90908493.33300Replenished 1001823796 3049396293
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777641 MR001646910002/12/202102/12/202102/13/202160505257909ATORVASTATIN 20 MG TABLET20 MGTABLET909090100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777641 MR001646910105/20/202105/20/202105/21/202160505257909ATORVASTATIN 20 MG TABLET20 MGTABLET90902426.66700Replenished 1001862128 3056474256