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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 000000791088 MR000820700403/27/202303/27/202304/26/202300169413013OZEMPIC 1 MG/DOSE (4 MG/3 ML)1/0.75 (3)PEN INJCTR333100.00000Replenished05/03/2023 1002211394 3131571412
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795067 MR002955950303/20/202303/20/202304/22/202300169413013OZEMPIC 1 MG/DOSE (4 MG/3 ML)1/0.75 (3)PEN INJCTR333100.00000Replenished04/24/2023 1002210018 3131049740
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795067 MR002955950404/11/202304/11/202305/11/202300169413013OZEMPIC 1 MG/DOSE (4 MG/3 ML)1/0.75 (3)PEN INJCTR333100.00000Replenished05/15/2023 1002220501 3133296965
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795067 MR002955950505/18/202305/18/202305/19/202300169413013OZEMPIC 1 MG/DOSE (4 MG/3 ML)1/0.75 (3)PEN INJCTR333100.00000Replenished05/22/2023 1002222095 3134071095
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797759 MR000820700005/04/202305/04/202305/05/202300169413013OZEMPIC 1 MG/DOSE (4 MG/3 ML)1/0.75 (3)PEN INJCTR333100.00000Replenished05/08/2023 1002213418 3132524753
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797759 MR000820700106/12/202306/12/202306/13/202300169413013OZEMPIC 1 MG/DOSE (4 MG/3 ML)1/0.75 (3)PEN INJCTR333100.00000Replenished06/14/2023 1002233505 3136619883