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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 000000780192 MR000105290002/26/202102/26/202102/26/202100069024430TOVIAZ ER 8 MG TABLET8 MGTAB.SR 24H30903033.33300Replenished 1001818440 988063362
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000780192 MR000105290002/26/202102/26/202102/26/202100069024430TOVIAZ ER 8 MG TABLET8 MGTAB.SR 24H30903033.33300Replenished 1001818440 988063362
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000780192 MR000105290002/26/202102/26/202102/26/202100069024430TOVIAZ ER 8 MG TABLET8 MGTAB.SR 24H30903033.33400Replenished 1001818440 988063362
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000780430 MR000745000003/10/202103/10/202103/10/202100069024430TOVIAZ ER 8 MG TABLET8 MGTAB.SR 24H30903033.33300Replenished 1001824882 3049647435
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000780430 MR000745000003/10/202103/10/202103/10/202100069024430TOVIAZ ER 8 MG TABLET8 MGTAB.SR 24H30903033.33300Replenished 1001824882 3049647435
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000780430 MR000745000003/10/202103/10/202103/10/202100069024430TOVIAZ ER 8 MG TABLET8 MGTAB.SR 24H30903033.33400Replenished 1001824882 3049647435
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000780430 MR000745000106/22/202106/22/202106/22/202100069024430TOVIAZ ER 8 MG TABLET8 MGTAB.SR 24H30903033.33300Replenished 1001878574 3059465018
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000780430 MR000745000106/22/202106/22/202106/22/202100069024430TOVIAZ ER 8 MG TABLET8 MGTAB.SR 24H30903033.33300Replenished 1001878574 3059465018
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000780430 MR000745000106/22/202106/22/202106/22/202100069024430TOVIAZ ER 8 MG TABLET8 MGTAB.SR 24H30903033.33400Replenished 1001878574 3059465018
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780430 MR000745000212/01/202112/01/202112/02/202100069024430TOVIAZ ER 8 MG TABLET8 MGTAB.SR 24H30903033.33300Replenished 1001965736 3075594883