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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 000000783149 MR002086360007/07/202107/07/202107/08/202100406117003NALTREXONE 50 MG TABLET50 MGTABLET30903033.33300Replenished 1001886700 3060956655
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783149 MR002086360007/07/202107/07/202107/08/202100406117003NALTREXONE 50 MG TABLET50 MGTABLET30903033.33300Replenished 1001886700 3060956655
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783149 MR002086360007/07/202107/07/202107/08/202100406117003NALTREXONE 50 MG TABLET50 MGTABLET30903033.33400Replenished 1001886700 3060956655
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790047 MR002880260005/05/202205/05/202205/06/202200406117003NALTREXONE 50 MG TABLET50 MGTABLET303030100.00000Replenished 1002046961 3092154961
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790815 MR002880260006/10/202206/10/202206/11/202200406117003NALTREXONE 50 MG TABLET50 MGTABLET303030100.00000Replenished 1002066046 3095834366
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792182 MR002880260008/15/202208/15/202208/16/202200406117003NALTREXONE 50 MG TABLET50 MGTABLET303030100.00000Replenished 1002094508 3103080550
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792182 MR002880260109/23/202209/23/202209/24/202200406117003NALTREXONE 50 MG TABLET50 MGTABLET303030100.00000Replenished 1002110752 3107139682