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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 000000790425 MR000186700611/22/202211/22/202211/23/202200093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1003013.33300Replenished 1002167601 3121067798
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791017 MR000380130006/21/202206/21/202206/22/202200093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1001616.25000Replenished 1002096808 3104187393
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789101 MR000380130003/22/202203/22/202203/23/202200093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1009333.33300Replenished 1002039367 3090544681
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000796526 MR002486460205/30/202305/30/202306/01/202300093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET10030310.00000Replenished06/05/2023 1002226246 3135522746
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779610 MR001340750002/02/202102/02/202102/03/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1008045.00000Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780189 MR000186700103/22/202103/22/202103/23/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET10030413.33300Replenished 1001897048 3062863316
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787212 MR000186700012/27/202112/27/202112/28/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET10030413.33300Replenished 1002024556 3087532840
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783617 MR000186700007/27/202107/27/202107/28/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET10030620.00000Replenished 1001897048 3062863316
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789101 MR000380130003/22/202203/22/202203/23/202200093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1009666.66700Replenished 1002024556 3087532840
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793997 MR003951960504/20/202304/20/202304/21/202300093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET10030723.33300Replenished06/05/2023 1002226246 3135522746