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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 000000781440 MR000925930004/23/202104/23/202104/23/202100469260230MYRBETRIQ ER 50 MG TABLET50 MGTAB.SR 24H303030100.00000Replenished 1001848263 3053810034
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000782131 MR000925930005/24/202105/24/202105/24/202100469260230MYRBETRIQ ER 50 MG TABLET50 MGTAB.SR 24H303030100.00000Replenished 1001863873 3056827847
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000782131 MR000925930106/24/202106/24/202106/24/202100469260230MYRBETRIQ ER 50 MG TABLET50 MGTAB.SR 24H303030100.00000Replenished 1001879825 3059776592
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000782131 MR000925930207/30/202107/30/202107/30/202100469260230MYRBETRIQ ER 50 MG TABLET50 MGTAB.SR 24H303030100.00000Replenished 1001898379 3063180504
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000782131 MR000925930308/31/202108/31/202108/31/202100469260230MYRBETRIQ ER 50 MG TABLET50 MGTAB.SR 24H303030100.00000Replenished 1001917460 3066543102
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000782131 MR000925930410/06/202110/06/202110/06/202100469260230MYRBETRIQ ER 50 MG TABLET50 MGTAB.SR 24H303030100.00000Replenished 1001936980 3069996256
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000782131 MR000925930511/05/202111/05/202111/05/202100469260230MYRBETRIQ ER 50 MG TABLET50 MGTAB.SR 24H303030100.00000Replenished 1001953128 3073037530