Back

Accumulator - View By Claim

Export to Excel

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 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 000000780234 MR002341130003/01/202103/01/202103/02/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET1002706022.22200Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780234 MR002341130003/01/202103/01/202103/02/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET10027010037.03700Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780234 MR002341130003/01/202103/01/202103/02/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET10027010037.03700Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780620 MR000557370003/18/202103/18/202103/19/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET1006060100.00000Replenished 1001835626 3051655272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781188 MR000557370004/13/202104/13/202104/14/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100602033.33300Replenished 1001867724 3057523425
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781188 MR000557370004/13/202104/13/202104/14/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100604066.66700Replenished 1001842802 3052853627
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781931 MR000557370005/13/202105/13/202105/14/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET1006060100.00000Replenished 1001867724 3057523425
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 000000782636 MR000557370006/14/202106/14/202106/15/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100605083.33300Replenished 1001874393 3058663336