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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 000004011234 MR001825340001/29/202101/29/202101/30/202100591024101LORAZEPAM 1 MG TABLET1 MGTABLET1005623.57100Replenished 1001803996
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011234 MR001825340001/29/202101/29/202101/30/202100591024101LORAZEPAM 1 MG TABLET1 MGTABLET100565496.42900Replenished 1001843344 3052979163
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011303 MR001825340003/02/202103/02/202103/03/202100591024101LORAZEPAM 1 MG TABLET1 MGTABLET100561017.85700Replenished 1001846719 3053644953
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011303 MR001825340003/02/202103/02/202103/03/202100591024101LORAZEPAM 1 MG TABLET1 MGTABLET100564682.14300Replenished 1001843344 3052979163
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011332 MR003090930003/17/202103/17/202103/18/202100591024101LORAZEPAM 1 MG TABLET1 MGTABLET1003030100.00000Replenished 1001846719 3053644953
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011375 MR001825340004/05/202104/05/202104/07/202100591024101LORAZEPAM 1 MG TABLET1 MGTABLET1005656100.00000Replenished 1001846719 3053644953
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011402 MR003090930004/20/202104/20/202104/21/202100591024101LORAZEPAM 1 MG TABLET1 MGTABLET10030413.33300Replenished 1001846719 3053644953
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011402 MR003090930004/20/202104/20/202104/21/202100591024101LORAZEPAM 1 MG TABLET1 MGTABLET100302686.66700Replenished 1001872170 3058237731
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011448 MR001825340005/06/202105/06/202105/07/202100591024101LORAZEPAM 1 MG TABLET1 MGTABLET1005656100.00000Replenished 1001872170 3058237731
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011519 MR001825340006/09/202106/09/202106/10/202100591024101LORAZEPAM 1 MG TABLET1 MGTABLET100561832.14300Replenished 1001872170 3058237731