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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 000000776448 MR002630840101/23/202101/23/202101/24/202170700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET845656100.00000Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780739 MR002630840003/24/202103/24/202103/25/202170700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84562850.00000Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775030 BLUC9JFJ7EEY0304/09/202104/09/202104/10/202170700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84845666.66700Replenished 1001841063 3052473905
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780739 MR002630840003/24/202103/24/202103/25/202170700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84562850.00000Replenished 1001841063 3052473905
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775030 BLUC9JFJ7EEY0304/09/202104/09/202104/10/202170700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84842833.33300Replenished 1001871620 3058108728
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781747 MR003915800005/06/202105/06/202105/07/202170700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET842828100.00000Replenished 1001871620 3058108728
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782497 MR002630840006/08/202106/08/202106/09/202170700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84562850.00000Replenished 1001871620 3058108728
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781747 MR003915800106/17/202106/17/202106/18/202170700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET842828100.00000Replenished 1001885854 3060825455
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782497 MR002630840006/08/202106/08/202106/09/202170700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84562850.00000Replenished 1001885854 3060825455
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783082 BLUC9JFJ7EEY0007/06/202107/06/202107/07/202170700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84842833.33300Replenished 1001885854 3060825455