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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 000000777523 MR002603410202/09/202102/09/202102/10/202108290320122BD UF NANO PEN NEEDLE 4MMX32G32GX 5/32"DIS NEEDLE1003030100.00000Replenished 1001827193 3050193214
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779326 MR000977320001/19/202101/19/202101/20/202108290320122BD UF NANO PEN NEEDLE 4MMX32G32GX 5/32"DIS NEEDLE1001004040.00000Replenished 1001798975
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779326 MR000977320001/19/202101/19/202101/20/202108290320122BD UF NANO PEN NEEDLE 4MMX32G32GX 5/32"DIS NEEDLE1001006060.00000Replenished 1001827193 3050193214
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779326 MR000977320110/27/202110/27/202110/28/202108290320122BD UF NANO PEN NEEDLE 4MMX32G32GX 5/32"DIS NEEDLE1001001010.00000Replenished 1001976721 3077692822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779326 MR000977320110/27/202110/27/202110/28/202108290320122BD UF NANO PEN NEEDLE 4MMX32G32GX 5/32"DIS NEEDLE1001009090.00000Replenished 1001950376 3072152537
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780578 MR002603410003/16/202103/16/202103/17/202108290320122BD UF NANO PEN NEEDLE 4MMX32G32GX 5/32"DIS NEEDLE100301033.33300Replenished 1001827193 3050193214
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780578 MR002603410003/16/202103/16/202103/17/202108290320122BD UF NANO PEN NEEDLE 4MMX32G32GX 5/32"DIS NEEDLE100302066.66700Replenished 1001880371 3059776593
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780578 MR002603410104/20/202104/20/202104/21/202108290320122BD UF NANO PEN NEEDLE 4MMX32G32GX 5/32"DIS NEEDLE1003030100.00000Replenished 1001880371 3059776593
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780578 MR002603410205/27/202105/27/202105/28/202108290320122BD UF NANO PEN NEEDLE 4MMX32G32GX 5/32"DIS NEEDLE1003030100.00000Replenished 1001880371 3059776593
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780578 MR002603410306/25/202106/25/202106/26/202108290320122BD UF NANO PEN NEEDLE 4MMX32G32GX 5/32"DIS NEEDLE100301033.33300Replenished 1001924089 3068049068