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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 000000790442 MR000943630111/21/202211/21/202211/22/202267877048330TELMISARTAN 40 MG TABLET40 MGTABLET301803016.66500Replenished 1002138660 3113575596
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790442 MR000943630111/21/202211/21/202211/22/202267877048330TELMISARTAN 40 MG TABLET40 MGTABLET301803016.66700Replenished 1002138660 3113575596
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790442 MR000943630111/21/202211/21/202211/22/202267877048330TELMISARTAN 40 MG TABLET40 MGTABLET301803016.66700Replenished 1002138660 3113575596
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790442 MR000943630111/21/202211/21/202211/22/202267877048330TELMISARTAN 40 MG TABLET40 MGTABLET301803016.66700Replenished 1002138660 3113575596
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790442 MR000943630111/21/202211/21/202211/22/202267877048330TELMISARTAN 40 MG TABLET40 MGTABLET301803016.66700Replenished 1002138660 3113575596
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790442 MR000943630111/21/202211/21/202211/22/202267877048330TELMISARTAN 40 MG TABLET40 MGTABLET301803016.66700Replenished 1002138660 3113575596
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790442 MR000943630005/24/202205/24/202205/25/202267877048330TELMISARTAN 40 MG TABLET40 MGTABLET301803016.66500Replenished 1002058117 3094226560
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790442 MR000943630005/24/202205/24/202205/25/202267877048330TELMISARTAN 40 MG TABLET40 MGTABLET301803016.66700Replenished 1002058117 3094226560
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790442 MR000943630005/24/202205/24/202205/25/202267877048330TELMISARTAN 40 MG TABLET40 MGTABLET301803016.66700Replenished 1002058117 3094226560
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790442 MR000943630005/24/202205/24/202205/25/202267877048330TELMISARTAN 40 MG TABLET40 MGTABLET301803016.66700Replenished 1002058117 3094226560