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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)Cash 340B 000000779996 MR000925930002/18/202102/18/202102/18/202100469260130MYRBETRIQ ER 25 MG TABLET25 MGTAB.SR 24H303030100.00000Replenished 1001814475 987756775
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000780860 MR000925930003/29/202103/29/202103/29/202100469260130MYRBETRIQ ER 25 MG TABLET25 MGTAB.SR 24H303030100.00000Replenished 1001834470 3051403572
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782112 BL4JELS4CV9C0106/24/202106/24/202107/20/202100469260130MYRBETRIQ ER 25 MG TABLET25 MGTAB.SR 24H303030100.00000Replenished 1001891615 3062304712
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782422 MR002010450006/04/202106/04/202106/15/202100469260130MYRBETRIQ ER 25 MG TABLET25 MGTAB.SR 24H303030100.00000Replenished 1001874950 3058793435
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782422 MR002010450208/09/202108/09/202108/19/202100469260130MYRBETRIQ ER 25 MG TABLET25 MGTAB.SR 24H303030100.00000Replenished 1001906487 3065291855
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782422 MR002010450309/14/202109/14/202109/20/202100469260130MYRBETRIQ ER 25 MG TABLET25 MGTAB.SR 24H303030100.00000Replenished 1001924949 3068173358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793083 MR002010450009/26/202209/26/202210/06/202200469260130MYRBETRIQ ER 25 MG TABLET25 MGTAB.SR 24H30603050.00000Replenished 1002118784 3108448503
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793083 MR002010450009/26/202209/26/202210/06/202200469260130MYRBETRIQ ER 25 MG TABLET25 MGTAB.SR 24H30603050.00000Replenished 1002118784 3108448503