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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 000000783961 MR000557370008/11/202108/11/202108/12/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET1006058.33300Replenished 1001918470 3066738110
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785291 MR000557370111/03/202111/03/202111/04/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET1006058.33300Replenished 1001952427 3072856896
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788687 MR002341130003/03/202203/03/202203/04/202262332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET1009055.55600Replenished 1002015325 3085493191
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780234 MR002341130003/01/202103/01/202103/02/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100270103.70400Replenished 1001835626 3051655272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782636 MR000557370006/14/202106/14/202106/15/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100601016.66700Replenished 1001891938 3062350528
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785291 MR000557370705/02/202205/02/202205/03/202262332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100601016.66700Replenished 1002045985 3091824990
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785291 MR000557370705/02/202205/02/202205/03/202262332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100601016.66700Replenished 1002045985 3091824990
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785291 MR000557370907/01/202207/01/202207/02/202262332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100601016.66700Replenished 1002075849 3098184654
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785291 MR000557371109/01/202209/01/202209/02/202262332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100601016.66700Replenished 1002100079 3104971541
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793866 MR000557370010/31/202210/31/202211/01/202262332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100601016.66700Replenished 1002128006 3111198052