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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 000000790646 MR002091460006/01/202206/01/202206/02/202224979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1002060712 3095062961
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790421 MR000186700005/23/202205/23/202205/24/202224979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1002057770 3094089034
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790421 MR000186700106/21/202206/21/202206/22/202224979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1002070948 3097196337
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790421 MR000186700207/25/202207/25/202207/26/202224979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1002083390 3100621822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790421 MR000186700308/24/202208/24/202208/25/202224979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1002102488 3105614645
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789503 MR002183130004/12/202204/12/202204/13/202224979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1002035636 3089579960
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789503 MR002183130105/12/202205/12/202205/13/202224979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1002051432 3092898161
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789503 MR002183130206/28/202206/28/202206/29/202224979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1002075262 3097972963
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789503 MR002183130307/22/202207/22/202207/23/202224979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1002082948 3100356573
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788485 MR000186700002/22/202202/22/202202/23/202224979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1002043399 3091212807