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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 000000776364 MR001513540402/10/202102/10/202102/11/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779314 MR002183130102/16/202102/16/202102/17/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001811909 987581092
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779485 MR000186700102/24/202102/24/202102/25/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001816771 988000091
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776364 MR001513540503/12/202103/12/202103/13/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001825961 3049810904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779485 MR000186700203/22/202103/22/202103/23/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779314 MR002183130203/23/202103/23/202103/25/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774248 MR001174460303/24/202103/24/202103/25/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H30903033.33300Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774248 MR001174460303/24/202103/24/202103/25/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H30903033.33300Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774248 MR001174460303/24/202103/24/202103/25/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H30903033.33400Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776364 MR001513540604/13/202104/13/202104/14/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001842802 3052853627