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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 000004011122 18820012/10/202012/10/202012/11/202000406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100901011.11100Replenished 1001833661 3051191520
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011122 18820012/10/202012/10/202012/11/202000406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100908088.88900Replenished 1001777465
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011156 MR000255130012/28/202012/28/202012/29/202000406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET1004040100.00000Replenished 1001833661 3051191520
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011202 MR000255130001/14/202101/14/202101/15/202100406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET1004040100.00000Replenished 1001833661 3051191520
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011342 18820003/26/202103/26/202103/28/202100406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET1009090100.00000Replenished 1001833661 3051191520
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011354 MR000255130003/26/202103/26/202103/28/202100406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100401025.00000Replenished 1001833661 3051191520
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011354 MR000255130003/26/202103/26/202103/28/202100406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100401025.00000Replenished 1001833661 3051191520
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011354 MR000255130003/26/202103/26/202103/28/202100406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100402050.00000Replenished 1001868295 3057602222
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011506 18820006/02/202106/02/202106/03/202100406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100901011.11100Replenished 1001900472 3063887830
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011506 18820006/02/202106/02/202106/03/202100406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100908088.88900Replenished 1001868295 3057602222