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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 000000774407 MR000380130006/22/202006/22/202006/24/202000378615501DIGITEK 125 MCG TABLET125 MCGTABLET1001515100.00000Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774834 MR000380130007/15/202007/15/202007/16/202000378615501DIGITEK 125 MCG TABLET125 MCGTABLET1001515100.00000Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775553 MR000380130008/10/202008/10/202008/12/202000378615501DIGITEK 125 MCG TABLET125 MCGTABLET1001515100.00000Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776200 MR000380130009/08/202009/08/202009/09/202000378615501DIGITEK 125 MCG TABLET125 MCGTABLET1001515100.00000Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777538 MR000380130011/02/202011/02/202011/03/202000378615501DIGITEK 125 MCG TABLET125 MCGTABLET1001515100.00000Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779319 MR000380130001/19/202101/19/202101/20/202100378615501DIGITEK 125 MCG TABLET125 MCGTABLET1001515100.00000Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780665 MR000380130003/22/202103/22/202103/23/202100378615501DIGITEK 125 MCG TABLET125 MCGTABLET100151066.66700Replenished 1001830087 3050733659