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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 000000782553 MR002211960006/09/202106/09/202106/09/202100173072020FLOVENT HFA 220 MCG INHALER220 MCGAER W/ADAP121212100.00000Replenished 1001872170 3058237732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000782553 MR002211960109/22/202109/22/202109/22/202100173072020FLOVENT HFA 220 MCG INHALER220 MCGAER W/ADAP121212100.00000Replenished 1001927409 3068590036
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000782553 MR002211960212/11/202112/11/202112/11/202100173072020FLOVENT HFA 220 MCG INHALER220 MCGAER W/ADAP121212100.00000Replenished 1001972369 3076588675
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777060 MR001114510304/05/202104/05/202104/07/202100173072020FLOVENT HFA 220 MCG INHALER220 MCGAER W/ADAP121212100.00000Replenished 1001838628 3052278967
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783018 MR001114510007/01/202107/01/202107/02/202100173072020FLOVENT HFA 220 MCG INHALER220 MCGAER W/ADAP121212100.00000Replenished 1001872170 3058237732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784348 MR001114510008/27/202108/27/202108/28/202100173072020FLOVENT HFA 220 MCG INHALER220 MCGAER W/ADAP121212100.00000Replenished 1001915815 3066004377
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785916 MR001114510011/01/202111/01/202111/02/202100173072020FLOVENT HFA 220 MCG INHALER220 MCGAER W/ADAP121212100.00000Replenished 1001951777 3072578295
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785916 MR001114510112/29/202112/29/202112/30/202100173072020FLOVENT HFA 220 MCG INHALER220 MCGAER W/ADAP121212100.00000Replenished 1001982259 3078646785
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785916 MR001114510202/15/202202/15/202202/16/202200173072020FLOVENT HFA 220 MCG INHALER220 MCGAER W/ADAP121212100.00000Replenished 1002007313 3083956625
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785916 MR001114510305/27/202205/27/202205/28/202200173072020FLOVENT HFA 220 MCG INHALER220 MCGAER W/ADAP121212100.00000Replenished 1002058998 3094409889