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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 000000785208 MR002937890010/01/202110/01/202110/02/202100591079501DICYCLOMINE 20 MG TABLET20 MGTABLET100451022.22200Replenished 1001935094 3069471044
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788916 MR002937890003/15/202203/15/202203/16/202200591079501DICYCLOMINE 20 MG TABLET20 MGTABLET100452044.44400Replenished 1002020152 3086903536
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785208 MR002937890010/01/202110/01/202110/02/202100591079501DICYCLOMINE 20 MG TABLET20 MGTABLET100453577.77800Replenished 1002020152 3086903536
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781137 MR002937890004/12/202104/12/202104/13/202100591079501DICYCLOMINE 20 MG TABLET20 MGTABLET1004545100.00000Replenished 1001935094 3069471044
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783017 MR002937890007/01/202107/01/202107/02/202100591079501DICYCLOMINE 20 MG TABLET20 MGTABLET1004545100.00000Replenished 1001935094 3069471044
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785208 MR002937890112/28/202112/28/202112/29/202100591079501DICYCLOMINE 20 MG TABLET20 MGTABLET1004545100.00000Replenished 1002020152 3086903536