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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 000000783830 MR003883610008/05/202108/06/202108/07/202160505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1003030100.00000Replenished 1001945251 3071148263
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785594 MR002897470010/18/202110/18/202110/19/202160505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET10045511.11100Replenished 1001989825 3080235785
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785594 MR002897470010/18/202110/18/202110/19/202160505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET100454088.88900Replenished 1001945251 3071148263
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788251 MR003883610002/11/202202/11/202202/12/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1003030100.00000Replenished 1002035636 3089579960
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788872 MR003883610003/11/202203/11/202203/12/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1003030100.00000Replenished 1002035636 3089579960
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791433 MR003883610007/11/202207/11/202207/12/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1003030100.00000Replenished 1002102296 3105614642
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794071 MR003883610011/08/202211/08/202211/09/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET100301550.00000Replenished 1002130060 3112131940
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794071 MR003883610011/08/202211/08/202211/09/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET100301550.00000Replenished 1002178117 3123055057
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794665 MR003883610012/05/202212/05/202212/06/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1003030100.00000Replenished 1002178117 3123055057
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783830 MR003883610109/07/202109/07/202109/08/202160505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1003030100.00000Replenished 1001945251 3071148263