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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)Cash 340B 000000780290 MR003617210003/02/202103/02/202103/02/202100591256230COLCHICINE 0.6 MG TABLET0.6 MGTABLET303030100.00000Replenished 1001819785 3048855808
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780896 MR000977320003/30/202103/30/202103/31/202100591256230COLCHICINE 0.6 MG TABLET0.6 MGTABLET3066100.00000Replenished 1001872170 3058237732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782547 MR001542460006/09/202106/09/202106/10/202100591256230COLCHICINE 0.6 MG TABLET0.6 MGTABLET30602440.00000Replenished 1001872170 3058237732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782547 MR001542460006/09/202106/09/202106/10/202100591256230COLCHICINE 0.6 MG TABLET0.6 MGTABLET30603050.00000Replenished 1001872170 3058237732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794454 MR003569430011/23/202211/23/202211/24/202200591256230COLCHICINE 0.6 MG TABLET0.6 MGTABLET306466.66700Replenished 1002161832 3119403854
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794989 MR000182390012/22/202212/22/202212/23/202200591256230COLCHICINE 0.6 MG TABLET0.6 MGTABLET3099100.00000Replenished 1002161832 3119403854
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795022 MR000435010101/09/202301/09/202301/10/202300591256230COLCHICINE 0.6 MG TABLET0.6 MGTABLET30301756.66700Replenished 1002161832 3119403854
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788837 MR000435010003/10/202203/10/202203/11/202200591256230COLCHICINE 0.6 MG TABLET0.6 MGTABLET3066100.00000Replenished 1002163795 3119751774
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789041 MR000435010003/21/202203/21/202203/22/202200591256230COLCHICINE 0.6 MG TABLET0.6 MGTABLET3066100.00000Replenished 1002163795 3119751774
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789311 MR000435010004/01/202204/01/202204/02/202200591256230COLCHICINE 0.6 MG TABLET0.6 MGTABLET3066100.00000Replenished 1002163795 3119751774