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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 000000781445 MR002564910004/23/202104/23/202104/24/202100591086105LISINOPRIL-HCTZ 20-12.5 MG TAB20-12.5 MGTABLET5009090100.00000Replenished 1002125076 3110431983
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781445 MR002564910110/20/202110/20/202110/26/202100591086105LISINOPRIL-HCTZ 20-12.5 MG TAB20-12.5 MGTABLET5009090100.00000Replenished 1002125076 3110431983
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781445 MR002564910204/01/202204/01/202204/02/202200591086105LISINOPRIL-HCTZ 20-12.5 MG TAB20-12.5 MGTABLET5009090100.00000Replenished 1002125076 3110431983
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783535 MR002798370007/23/202107/23/202107/24/202100591086105LISINOPRIL-HCTZ 20-12.5 MG TAB20-12.5 MGTABLET5006060100.00000Replenished 1002125076 3110431983
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783535 MR002798370109/21/202109/21/202109/22/202100591086105LISINOPRIL-HCTZ 20-12.5 MG TAB20-12.5 MGTABLET5006060100.00000Replenished 1002125076 3110431983
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792341 MR000069230008/22/202208/22/202208/25/202200591086105LISINOPRIL-HCTZ 20-12.5 MG TAB20-12.5 MGTABLET5009090100.00000Replenished 1002125076 3110431983
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793739 MR002564910010/24/202210/24/202210/25/202200591086105LISINOPRIL-HCTZ 20-12.5 MG TAB20-12.5 MGTABLET500452044.44400Replenished 1002125076 3110431983