Back

Accumulator - View By Claim

Export to Excel

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 000000782174 MR002418560005/25/202105/25/202106/11/202116571065710CEVIMELINE HCL 30 MG CAPSULE30 MGCAPSULE100100100100.00000Replenished 1001873325 3058406861
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782174 MR002418560308/23/202108/23/202109/18/202116571065710CEVIMELINE HCL 30 MG CAPSULE30 MGCAPSULE100100100100.00000Replenished 1001924438 3068049381
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782174 MR002418560411/01/202111/01/202111/03/202116571065710CEVIMELINE HCL 30 MG CAPSULE30 MGCAPSULE100100100100.00000Replenished 1001952043 3072719019
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782174 MR002418560612/23/202112/23/202112/25/202116571065710CEVIMELINE HCL 30 MG CAPSULE30 MGCAPSULE100100100100.00000Replenished 1001978506 3078024706
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782174 MR002418560701/20/202201/20/202201/22/202216571065710CEVIMELINE HCL 30 MG CAPSULE30 MGCAPSULE100100100100.00000Replenished 1001993278 3080996427