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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 000000783726 MR001742450008/02/202108/02/202108/02/202100074433902HUMIRA PEN 40 MG/0.8 ML40MG/0.8MLPEN IJ KIT222100.00000Replenished 1001899045 3063437222
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000784770 MR001742450009/14/202109/14/202109/14/202100074433902HUMIRA PEN 40 MG/0.8 ML40MG/0.8MLPEN IJ KIT222100.00000Replenished 1001923412 3067730838
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000784770 MR001742450110/21/202110/21/202110/21/202100074433902HUMIRA PEN 40 MG/0.8 ML40MG/0.8MLPEN IJ KIT222100.00000Replenished 1001946740 3071601882
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000784770 MR001742450212/09/202112/09/202112/09/202100074433902HUMIRA PEN 40 MG/0.8 ML40MG/0.8MLPEN IJ KIT222100.00000Replenished 1001971456 3076588673
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000787616 MR001742450001/12/202201/12/202201/12/202200074433902HUMIRA PEN 40 MG/0.8 ML40MG/0.8MLPEN IJ KIT222100.00000Replenished 1001989205 3080047510
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789042 MR001742450003/21/202203/21/202203/22/202200074433902HUMIRA PEN 40 MG/0.8 ML40MG/0.8MLPEN IJ KIT222100.00000Replenished 1002023985 3087397632