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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 000004011879 MR001082060011/23/202111/23/202111/24/202100121092816PROMETHAZINE-CODEINE SOLUTION6.25-10/5SYRUP473200200100.00000Replenished 1002070948 3097196336
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011954 MR000166040001/04/202201/04/202201/05/202200121092816PROMETHAZINE-CODEINE SOLUTION6.25-10/5SYRUP473118118100.00000Replenished 1002070948 3097196336
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011993 MR002876580001/20/202201/20/202201/21/202200121092816PROMETHAZINE-CODEINE SOLUTION6.25-10/5SYRUP473118118100.00000Replenished 1002070948 3097196336
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012228 MR000272440006/21/202206/21/202206/22/202200121092816PROMETHAZINE-CODEINE SOLUTION6.25-10/5SYRUP4731203730.83300Replenished 1002070948 3097196336
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012228 MR000272440006/21/202206/21/202206/22/202200121092816PROMETHAZINE-CODEINE SOLUTION6.25-10/5SYRUP4731208369.16700Replenished 1002165771 3120576241
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012330 MR003101930008/25/202208/25/202208/26/202200121092816PROMETHAZINE-CODEINE SOLUTION6.25-10/5SYRUP473118118100.00000Replenished 1002165771 3120576241
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012427 MR003907370011/10/202211/10/202211/11/202200121092816PROMETHAZINE-CODEINE SOLUTION6.25-10/5SYRUP473118118100.00000Replenished 1002165771 3120576241
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012431 MR000985750011/10/202211/10/202211/11/202200121092816PROMETHAZINE-CODEINE SOLUTION6.25-10/5SYRUP473120120100.00000Replenished 1002165771 3120576241
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012489 MR001579510012/19/202212/19/202212/20/202200121092816PROMETHAZINE-CODEINE SOLUTION6.25-10/5SYRUP4731203428.33300Replenished 1002165771 3120576241