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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 000000778543 109900103/18/202103/18/202103/19/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1009090100.00000Replenished 1001828853 3050481048
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778543 109900206/16/202106/16/202106/17/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1009044.44400Replenished 1001875545 3059020609
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778543 109900206/16/202106/16/202106/17/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100901011.11100Replenished 1001875545 3059020609
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778543 109900206/16/202106/16/202106/17/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100907684.44500Replenished 1001876579 3059092930
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780716 18820003/22/202103/23/202103/25/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100901011.11100Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780716 18820003/22/202103/23/202103/25/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100903235.55600Replenished 1001834470 3051403572
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780716 18820003/22/202103/23/202103/25/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100904853.33300Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781792 22401450005/10/202105/10/202105/11/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1009090100.00000Replenished 1001856282 3055381317
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779225 247830104/14/202104/14/202104/15/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100901820.00000Replenished 1001843344 3052979164
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779225 247830104/14/202104/14/202104/15/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100907280.00000Replenished 1001846719 3053644954