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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 000000772327 MR002275850401/14/202101/14/202101/15/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET84842833.33300Replenished 1001816056 987916714
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776785 MR003927550201/22/202101/22/202101/23/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001816056 987916714
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776785 MR003927550302/22/202102/22/202102/23/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001816056 987916714
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776785 MR003927550403/22/202103/22/202103/23/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776785 MR003927550504/19/202104/19/202104/20/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001854421 3055134799
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776785 MR003927550605/17/202105/17/202105/18/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001854421 3055134799
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776785 MR003927550706/14/202106/14/202106/15/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001891615 3062304712
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776785 MR003927550807/12/202107/12/202107/13/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001891615 3062304712
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776785 MR003927550908/09/202108/09/202108/10/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001919113 3067013098
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776785 MR003927551009/07/202109/07/202109/08/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001919113 3067013098