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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 000000796838 MR001697170003/21/202303/23/202303/24/202300781185220AMOX-CLAV 875-125 MG TABLET875-125 MGTABLET202020100.00000Replenished 1002195085 3127879945
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797048 MR003261530003/31/202303/31/202304/01/202300781185220AMOX-CLAV 875-125 MG TABLET875-125 MGTABLET201414100.00000Replenished 1002199093 3129254774
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797139 MR002793580004/05/202304/05/202304/06/202300781185220AMOX-CLAV 875-125 MG TABLET875-125 MGTABLET2020630.00000Replenished 1002199093 3129254774
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797139 MR002793580004/05/202304/05/202304/06/202300781185220AMOX-CLAV 875-125 MG TABLET875-125 MGTABLET20201470.00000Replenished04/17/2023 1002207066 3130202878
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797312 MR002505580004/13/202304/13/202304/14/202300781185220AMOX-CLAV 875-125 MG TABLET875-125 MGTABLET2010660.00000Replenished04/17/2023 1002207066 3130202878