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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)Cash 340B 000000775539 MR000620750103/03/202103/03/202103/03/202100173069600ADVAIR 250-50 DISKUS250-50 MCGDISK W/DEV606060100.00000Replenished 1001821238 3048978888
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000780019 MR003892430002/19/202102/19/202102/19/202100173069600ADVAIR 250-50 DISKUS250-50 MCGDISK W/DEV606060100.00000Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000780825 MR003892430003/29/202103/29/202103/29/202100173069600ADVAIR 250-50 DISKUS250-50 MCGDISK W/DEV606060100.00000Replenished 1001834470 3051403572
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000780825 MR003892430105/13/202105/13/202105/13/202100173069600ADVAIR 250-50 DISKUS250-50 MCGDISK W/DEV606060100.00000Replenished 1001858827 3055792360
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000780825 MR003892430207/01/202107/01/202107/01/202100173069600ADVAIR 250-50 DISKUS250-50 MCGDISK W/DEV606060100.00000Replenished 1001884259 3060456965
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000783544 BVW9TRCC2UKS0007/23/202107/23/202107/23/202100173069600ADVAIR 250-50 DISKUS250-50 MCGDISK W/DEV606060100.00000Replenished 1001895483 3062473634
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000784393 MR003892430008/30/202108/30/202108/30/202100173069600ADVAIR 250-50 DISKUS250-50 MCGDISK W/DEV606060100.00000Replenished 1001916855 3066262939
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000784393 MR003892430110/25/202110/25/202110/25/202100173069600ADVAIR 250-50 DISKUS250-50 MCGDISK W/DEV606060100.00000Replenished 1001948371 3071858707
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000784393 MR003892430212/10/202112/10/202112/10/202100173069600ADVAIR 250-50 DISKUS250-50 MCGDISK W/DEV606060100.00000Replenished 1001972080 3076588674
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000786626 MR000620750012/01/202112/01/202112/01/202100173069600ADVAIR 250-50 DISKUS250-50 MCGDISK W/DEV606060100.00000Replenished 1001965736 3075594883