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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 000000777646 MR000876280205/26/202105/26/202105/27/202116729000515SIMVASTATIN 20 MG TABLET20 MGTABLET90903033.33300Replenished 1001864958 3056990723
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777646 MR000876280205/26/202105/26/202105/27/202116729000515SIMVASTATIN 20 MG TABLET20 MGTABLET90906066.66700Replenished 1001867724 3057523425
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780667 MR000220060205/18/202105/18/202105/19/202116729000515SIMVASTATIN 20 MG TABLET20 MGTABLET903030100.00000Replenished 1001864958 3056990723
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782069 MR000657220005/20/202105/20/202105/21/202116729000515SIMVASTATIN 20 MG TABLET20 MGTABLET903030100.00000Replenished 1001864958 3056990723
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782334 MR003261530006/01/202106/01/202106/02/202116729000515SIMVASTATIN 20 MG TABLET20 MGTABLET90903033.33300Replenished 1001867724 3057523425
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782334 MR003261530006/01/202106/01/202106/02/202116729000515SIMVASTATIN 20 MG TABLET20 MGTABLET90906066.66700Replenished 1001872170 3058237732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782542 MR003193250006/09/202106/09/202106/10/202116729000515SIMVASTATIN 20 MG TABLET20 MGTABLET90903033.33300Replenished 1001872170 3058237732