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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 000000781115 MR000182390004/09/202104/09/202104/09/202100173069700ADVAIR 500-50 DISKUS500-50 MCGDISK W/DEV606060100.00000Replenished 1001841063 3052473905
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000783408 MR000182390007/19/202107/19/202107/19/202100173069700ADVAIR 500-50 DISKUS500-50 MCGDISK W/DEV606060100.00000Replenished 1001891373 3062039555
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000783408 MR000182390110/14/202110/14/202110/14/202100173069700ADVAIR 500-50 DISKUS500-50 MCGDISK W/DEV606060100.00000Replenished 1001940281 3070884325
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000783408 MR000182390212/28/202112/28/202112/28/202100173069700ADVAIR 500-50 DISKUS500-50 MCGDISK W/DEV606060100.00000Replenished 1001981624 3078485431
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000783408 MR000182390303/08/202203/08/202203/08/202200173069700ADVAIR 500-50 DISKUS500-50 MCGDISK W/DEV606060100.00000Replenished 1002017255 3085917756
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785354 MR003928040010/07/202110/07/202110/07/202100173069700ADVAIR 500-50 DISKUS500-50 MCGDISK W/DEV606060100.00000Replenished 1001937905 3070173196
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785354 MR003928040111/02/202111/02/202111/02/202100173069700ADVAIR 500-50 DISKUS500-50 MCGDISK W/DEV606060100.00000Replenished 1001952043 3072719019
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785354 MR003928040211/29/202111/29/202111/29/202100173069700ADVAIR 500-50 DISKUS500-50 MCGDISK W/DEV606060100.00000Replenished 1001965091 3075301281
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785354 MR003928040312/29/202112/29/202112/29/202100173069700ADVAIR 500-50 DISKUS500-50 MCGDISK W/DEV606060100.00000Replenished 1001982259 3078646785
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000785354 MR003928040401/26/202201/26/202201/26/202200173069700ADVAIR 500-50 DISKUS500-50 MCGDISK W/DEV606060100.00000Replenished 1001995544 3081589524