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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 000000795948 MR000551480305/04/202305/04/202305/05/202300006027731JANUVIA 100 MG TABLET100 MGTABLET303030100.00000Replenished05/08/2023 1002213418 3132524753
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795948 MR000551480204/11/202304/11/202304/13/202300006027731JANUVIA 100 MG TABLET100 MGTABLET303030100.00000Replenished04/17/2023 1002207066 3130202878
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000773883 MR003893710304/28/202104/28/202104/28/202100006027731JANUVIA 100 MG TABLET100 MGTABLET30903033.33300Replenished 1001850290 3054303929
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000773883 MR003893710304/28/202104/28/202104/28/202100006027731JANUVIA 100 MG TABLET100 MGTABLET30903033.33300Replenished 1001850290 3054303929
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000773883 MR003893710304/28/202104/28/202104/28/202100006027731JANUVIA 100 MG TABLET100 MGTABLET30903033.33400Replenished 1001850290 3054303929
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000783627 MR003893710007/28/202107/28/202107/28/202100006027731JANUVIA 100 MG TABLET100 MGTABLET30903033.33300Replenished 1001897770 3062993331
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000783627 MR003893710007/28/202107/28/202107/28/202100006027731JANUVIA 100 MG TABLET100 MGTABLET30903033.33300Replenished 1001897770 3062993331
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000783627 MR003893710007/28/202107/28/202107/28/202100006027731JANUVIA 100 MG TABLET100 MGTABLET30903033.33400Replenished 1001897770 3062993331
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777952 MR000551480302/15/202102/15/202102/16/202100006027731JANUVIA 100 MG TABLET100 MGTABLET303030100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780669 MR000551480003/22/202103/22/202103/23/202100006027731JANUVIA 100 MG TABLET100 MGTABLET303030100.00000Replenished 1001830087 3050733659