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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 000000779832 MR001011130006/04/202106/04/202106/05/202100093727098PRAVASTATIN SODIUM 80 MG TAB80 MGTABLET903030100.00000Replenished 1001904342 3064710333
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781574 MR000790050004/29/202104/29/202104/30/202100093727098PRAVASTATIN SODIUM 80 MG TAB80 MGTABLET909090100.00000Replenished 1001850989 3054468652
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781574 MR000790050107/28/202107/28/202107/29/202100093727098PRAVASTATIN SODIUM 80 MG TAB80 MGTABLET90903033.33300Replenished 1001922312 3067326646
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781574 MR000790050107/28/202107/28/202107/29/202100093727098PRAVASTATIN SODIUM 80 MG TAB80 MGTABLET90906066.66700Replenished 1001904342 3064710333
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781574 MR000790050211/02/202111/02/202111/03/202100093727098PRAVASTATIN SODIUM 80 MG TAB80 MGTABLET90903033.33300Replenished 1001956560 3073437016
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781574 MR000790050211/02/202111/02/202111/03/202100093727098PRAVASTATIN SODIUM 80 MG TAB80 MGTABLET90906066.66700Replenished 1001952043 3072719019
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781845 MR003892450005/11/202105/11/202105/12/202100093727098PRAVASTATIN SODIUM 80 MG TAB80 MGTABLET909090100.00000Replenished 1001857662 3055508681
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783710 MR001011130008/02/202108/02/202108/03/202100093727098PRAVASTATIN SODIUM 80 MG TAB80 MGTABLET903030100.00000Replenished 1001922312 3067326646
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783710 MR001011130109/10/202109/10/202109/11/202100093727098PRAVASTATIN SODIUM 80 MG TAB80 MGTABLET903030100.00000Replenished 1001922312 3067326646
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783710 MR001011130210/14/202110/14/202110/15/202100093727098PRAVASTATIN SODIUM 80 MG TAB80 MGTABLET903030100.00000Replenished 1001952043 3072719019