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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 000000784782 MR000745000205/10/202205/10/202205/11/202200093738656VENLAFAXINE HCL ER 150 MG CAP150 MGCAP.SR 24H30901516.66700Replenished 1001188837
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784782 MR000745000205/10/202205/10/202205/11/202200093738656VENLAFAXINE HCL ER 150 MG CAP150 MGCAP.SR 24H30901516.66700Replenished 1001195212
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784782 MR000745000205/10/202205/10/202205/11/202200093738656VENLAFAXINE HCL ER 150 MG CAP150 MGCAP.SR 24H30903033.33300Replenished 1001195212
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784782 MR000745000205/10/202205/10/202205/11/202200093738656VENLAFAXINE HCL ER 150 MG CAP150 MGCAP.SR 24H30903033.33300Replenished 1001195212
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787487 MR002028490205/02/202205/02/202205/03/202200093738656VENLAFAXINE HCL ER 150 MG CAP150 MGCAP.SR 24H303030100.00000Replenished 1001200828
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787487 MR002028490305/31/202205/31/202206/01/202200093738656VENLAFAXINE HCL ER 150 MG CAP150 MGCAP.SR 24H30301550.00000Replenished 1001188183
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787487 MR002028490305/31/202205/31/202206/01/202200093738656VENLAFAXINE HCL ER 150 MG CAP150 MGCAP.SR 24H30301550.00000Replenished 1001188183
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788510 MR002830170106/07/202206/07/202206/08/202200093738656VENLAFAXINE HCL ER 150 MG CAP150 MGCAP.SR 24H30901516.66700Replenished 1001166574
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788510 MR002830170106/07/202206/07/202206/08/202200093738656VENLAFAXINE HCL ER 150 MG CAP150 MGCAP.SR 24H30901516.66700Replenished 1001180414
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788510 MR002830170106/07/202206/07/202206/08/202200093738656VENLAFAXINE HCL ER 150 MG CAP150 MGCAP.SR 24H30903033.33300Replenished 1001170064