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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 000004011136 MR003085400203/03/202103/03/202103/04/202100781531701ZOLPIDEM TARTRATE 5 MG TABLET5 MGTABLET1003030100.00000Replenished 1001822785 3049139688
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011136 MR003085400304/14/202104/14/202104/15/202100781531701ZOLPIDEM TARTRATE 5 MG TABLET5 MGTABLET1003030100.00000Replenished 1001843344 3052979163
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011136 MR003085400405/13/202105/13/202105/14/202100781531701ZOLPIDEM TARTRATE 5 MG TABLET5 MGTABLET10030516.66700Replenished 1001858827 3055792099
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011136 MR003085400405/13/202105/13/202105/14/202100781531701ZOLPIDEM TARTRATE 5 MG TABLET5 MGTABLET100302583.33300Replenished 1001873325 3058406860
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011227 MR000732600001/26/202101/26/202101/27/202100781531701ZOLPIDEM TARTRATE 5 MG TABLET5 MGTABLET10030516.66700Replenished 1001822785 3049139688
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011227 MR000732600001/26/202101/26/202101/27/202100781531701ZOLPIDEM TARTRATE 5 MG TABLET5 MGTABLET100302583.33300Replenished 1001802067
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011276 BS9YX6AB5BJS0002/19/202102/19/202102/20/202100781531701ZOLPIDEM TARTRATE 5 MG TABLET5 MGTABLET1003030100.00000Replenished 1001822785 3049139688
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011281 MR000732600002/22/202102/22/202102/23/202100781531701ZOLPIDEM TARTRATE 5 MG TABLET5 MGTABLET1003030100.00000Replenished 1001822785 3049139688
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011309 MR002232670003/05/202103/05/202103/06/202100781531701ZOLPIDEM TARTRATE 5 MG TABLET5 MGTABLET1009055.55600Replenished 1001822785 3049139688
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011309 MR002232670003/05/202103/05/202103/06/202100781531701ZOLPIDEM TARTRATE 5 MG TABLET5 MGTABLET100908594.44400Replenished 1001830087 3050733658