Back

Accumulator - View By Claim

Export to Excel

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 000000796092 MR000303240002/13/202302/13/202302/13/202300310737020BUDESONIDE-FORMOTEROL 160-4.5160-4.5MCGHFA AER AD10.210.210.2100.00000Replenished 1002178681 3123384823
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789437 MR000670640004/08/202204/08/202204/09/202200310737020BUDESONIDE-FORMOTEROL 160-4.5160-4.5MCGHFA AER AD10.210.210.2100.00000Replenished 1002032229 3089169383
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789437 MR000670640105/12/202205/12/202205/13/202200310737020BUDESONIDE-FORMOTEROL 160-4.5160-4.5MCGHFA AER AD10.210.210.2100.00000Replenished 1002051432 3092898161
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789437 MR000670640206/10/202206/10/202206/11/202200310737020BUDESONIDE-FORMOTEROL 160-4.5160-4.5MCGHFA AER AD10.210.210.2100.00000Replenished 1002066046 3095834366
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789437 MR000670640307/11/202207/11/202207/12/202200310737020BUDESONIDE-FORMOTEROL 160-4.5160-4.5MCGHFA AER AD10.210.210.2100.00000Replenished 1002078923 3099104399
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789437 MR000670640408/08/202208/08/202208/09/202200310737020BUDESONIDE-FORMOTEROL 160-4.5160-4.5MCGHFA AER AD10.210.210.2100.00000Replenished 1002088256 3102157587
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789437 MR000670640509/15/202209/15/202209/16/202200310737020BUDESONIDE-FORMOTEROL 160-4.5160-4.5MCGHFA AER AD10.210.210.2100.00000Replenished 1002108257 3106376963
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789437 MR000670640610/11/202210/11/202210/12/202200310737020BUDESONIDE-FORMOTEROL 160-4.5160-4.5MCGHFA AER AD10.210.210.2100.00000Replenished 1002120414 3109055000
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789437 MR000670640711/09/202211/09/202211/10/202200310737020BUDESONIDE-FORMOTEROL 160-4.5160-4.5MCGHFA AER AD10.210.210.2100.00000Replenished 1002130385 3112283351
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789437 MR000670640812/12/202212/12/202212/13/202200310737020BUDESONIDE-FORMOTEROL 160-4.5160-4.5MCGHFA AER AD10.210.210.2100.00000Replenished 1002149821 3116206380