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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 000000774134 MR000374450702/17/202102/17/202102/18/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET903030100.00000Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774134 MR000374450803/29/202103/29/202103/30/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET90301550.00000Replenished 1001834470 3051403572
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774134 MR000374450803/29/202103/29/202103/30/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET90301550.00000Replenished 1001842172 3052723058
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776323 MR002603410402/04/202102/04/202102/06/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET9030620.00000Replenished 1001807887
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776323 MR002603410402/04/202102/04/202102/06/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET90302480.00000Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776323 MR002603410503/08/202103/08/202103/09/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET903030100.00000Replenished 1001824202 3049524740
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776323 MR002603410604/08/202104/08/202104/09/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET903030100.00000Replenished 1001842172 3052723058
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776323 MR002603410705/07/202105/07/202105/08/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET903030100.00000Replenished 1001856282 3055381317
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776323 MR002603410806/08/202106/08/202106/09/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET903030100.00000Replenished 1001872170 3058237732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776323 MR002603410907/08/202107/08/202107/09/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET903030100.00000Replenished 1001889916 3061619489