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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 000000788725 MR003890110003/04/202203/04/202203/06/202200002318280TRULICITY 4.5 MG/0.5 ML PEN4.5 MG/0.5PEN INJCTR222100.00000Replenished 1002015623 3085493193
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788725 MR003890110105/06/202205/06/202205/07/202200002318280TRULICITY 4.5 MG/0.5 ML PEN4.5 MG/0.5PEN INJCTR222100.00000Replenished 1002047220 3092154963
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788725 MR003890110206/02/202206/02/202206/04/202200002318280TRULICITY 4.5 MG/0.5 ML PEN4.5 MG/0.5PEN INJCTR222100.00000Replenished 1002062156 3095062963
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788725 MR003890110306/30/202206/30/202207/02/202200002318280TRULICITY 4.5 MG/0.5 ML PEN4.5 MG/0.5PEN INJCTR222100.00000Replenished 1002075849 3098184654
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788725 MR003890110407/28/202207/28/202207/30/202200002318280TRULICITY 4.5 MG/0.5 ML PEN4.5 MG/0.5PEN INJCTR222100.00000Replenished 1002085673 3101083319
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788725 MR003890110508/30/202208/30/202209/02/202200002318280TRULICITY 4.5 MG/0.5 ML PEN4.5 MG/0.5PEN INJCTR222100.00000Replenished 1002099737 3104970859
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788725 MR003890110609/24/202209/24/202209/26/202200002318280TRULICITY 4.5 MG/0.5 ML PEN4.5 MG/0.5PEN INJCTR222100.00000Replenished 1002111245 3107281990
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788725 MR003890110710/28/202210/28/202210/30/202200002318280TRULICITY 4.5 MG/0.5 ML PEN4.5 MG/0.5PEN INJCTR222100.00000Replenished 1002127559 3110896806
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788725 MR003890110811/19/202211/19/202211/20/202200002318280TRULICITY 4.5 MG/0.5 ML PEN4.5 MG/0.5PEN INJCTR222100.00000Replenished 1002150723 3116568650
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788725 MR003890110912/16/202212/16/202212/17/202200002318280TRULICITY 4.5 MG/0.5 ML PEN4.5 MG/0.5PEN INJCTR222100.00000Replenished 1002150980 3116568653