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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 000000778965 MR001341570001/04/202101/04/202101/05/202100054455025METHOTREXATE 2.5 MG TABLET2.5 MGTABLET10020735.00000Replenished 1001790379
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778965 MR001341570001/04/202101/04/202101/05/202100054455025METHOTREXATE 2.5 MG TABLET2.5 MGTABLET100201365.00000Replenished 1001846179 3053536547
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779544 MR001341570001/29/202101/29/202101/30/202100054455025METHOTREXATE 2.5 MG TABLET2.5 MGTABLET1002020100.00000Replenished 1001846179 3053536547
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780018 MR001923510204/15/202104/15/202104/21/202100054455025METHOTREXATE 2.5 MG TABLET2.5 MGTABLET1002813.57100Replenished 1001939962 3070708844
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780018 MR001923510204/15/202104/15/202104/21/202100054455025METHOTREXATE 2.5 MG TABLET2.5 MGTABLET100282796.42900Replenished 1001846179 3053536547
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780052 MR001341570002/22/202102/22/202102/23/202100054455025METHOTREXATE 2.5 MG TABLET2.5 MGTABLET1002020100.00000Replenished 1001846179 3053536547
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780840 MR001341570003/29/202103/29/202103/30/202100054455025METHOTREXATE 2.5 MG TABLET2.5 MGTABLET1002020100.00000Replenished 1001846179 3053536547
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782907 MR001923510006/30/202106/30/202107/20/202100054455025METHOTREXATE 2.5 MG TABLET2.5 MGTABLET1003030100.00000Replenished 1001939962 3070708844
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782907 MR001923510108/13/202108/13/202108/14/202100054455025METHOTREXATE 2.5 MG TABLET2.5 MGTABLET1003030100.00000Replenished 1001939962 3070708844
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782907 MR001923510209/13/202109/13/202109/14/202100054455025METHOTREXATE 2.5 MG TABLET2.5 MGTABLET1003030100.00000Replenished 1001939962 3070708844