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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 000000776643 MR000975870401/30/202101/30/202101/31/202150111064701FLUOXETINE HCL 10 MG CAPSULE10 MGCAPSULE100302066.66700Replenished 1001804274
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790420 MR000186701003/27/202303/27/202303/28/202350111064701FLUOXETINE HCL 10 MG CAPSULE10 MGCAPSULE100901011.11100Replenished 1001804274
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795679 MR000975870104/18/202304/18/202304/19/202350111064701FLUOXETINE HCL 10 MG CAPSULE10 MGCAPSULE100907077.77800Replenished04/19/2023 1001804274
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776643 MR000975870401/30/202101/30/202101/31/202150111064701FLUOXETINE HCL 10 MG CAPSULE10 MGCAPSULE100301033.33300Replenished 1001857662 3055508681
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776643 MR000975870503/03/202103/03/202103/04/202150111064701FLUOXETINE HCL 10 MG CAPSULE10 MGCAPSULE1003030100.00000Replenished 1001857662 3055508681
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776643 MR000975870604/02/202104/02/202104/03/202150111064701FLUOXETINE HCL 10 MG CAPSULE10 MGCAPSULE1003030100.00000Replenished 1001857662 3055508681
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776643 MR000975870705/01/202105/01/202105/02/202150111064701FLUOXETINE HCL 10 MG CAPSULE10 MGCAPSULE1003030100.00000Replenished 1001857662 3055508681
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776643 MR000975870806/03/202106/03/202106/04/202150111064701FLUOXETINE HCL 10 MG CAPSULE10 MGCAPSULE1003030100.00000Replenished 1001889250 3061354275
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776643 MR000975870907/12/202107/12/202107/13/202150111064701FLUOXETINE HCL 10 MG CAPSULE10 MGCAPSULE1003030100.00000Replenished 1001889250 3061354275
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783275 MR001778440007/12/202107/12/202107/13/202150111064701FLUOXETINE HCL 10 MG CAPSULE10 MGCAPSULE100904044.44400Replenished 1001889250 3061354275