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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 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 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 000004011593 MR001825340007/09/202107/09/202107/10/202100591024101LORAZEPAM 1 MG TABLET1 MGTABLET1005656100.00000Replenished 1001902816 3064329314
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011796 MR001825340010/11/202110/11/202110/12/202100591024101LORAZEPAM 1 MG TABLET1 MGTABLET1005656100.00000Replenished 1001957713 3073585554
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 000004011667 MR001825340008/10/202108/10/202108/11/202100591024101LORAZEPAM 1 MG TABLET1 MGTABLET100565089.28600Replenished 1001922312 3067326645
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011734 MR001825340009/10/202109/10/202109/11/202100591024101LORAZEPAM 1 MG TABLET1 MGTABLET100565089.28600Replenished 1001922312 3067326645
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 000004011519 MR001825340006/09/202106/09/202106/10/202100591024101LORAZEPAM 1 MG TABLET1 MGTABLET100563867.85700Replenished 1001902816 3064329314
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011864 MR001825340011/10/202111/10/202111/11/202100591024101LORAZEPAM 1 MG TABLET1 MGTABLET100563867.85700Replenished 1001957713 3073585554