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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 000004011614 MR001955620311/27/202111/27/202111/28/202100591024001LORAZEPAM 0.5 MG TABLET0.5 MGTABLET10030930.00000Replenished 1001964634 3075007286
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011614 MR001955620311/27/202111/27/202111/28/202100591024001LORAZEPAM 0.5 MG TABLET0.5 MGTABLET100302170.00000Replenished 1001975684 3077386381
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011614 MR001955620210/18/202110/18/202110/19/202100591024001LORAZEPAM 0.5 MG TABLET0.5 MGTABLET100301446.66700Replenished 1001945251 3071148262
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011614 MR001955620210/18/202110/18/202110/19/202100591024001LORAZEPAM 0.5 MG TABLET0.5 MGTABLET100301653.33300Replenished 1001952718 3073037128
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011614 MR001955620108/26/202108/26/202108/27/202100591024001LORAZEPAM 0.5 MG TABLET0.5 MGTABLET1003013.33300Replenished 1001921962 3067326643
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011614 MR001955620108/26/202108/26/202108/27/202100591024001LORAZEPAM 0.5 MG TABLET0.5 MGTABLET100302996.66700Replenished 1001911378 3066004375
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011235 MR002065140001/29/202101/29/202101/30/202100591024001LORAZEPAM 0.5 MG TABLET0.5 MGTABLET100452044.44400Replenished 1001826768 3050065355
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011235 MR002065140001/29/202101/29/202101/30/202100591024001LORAZEPAM 0.5 MG TABLET0.5 MGTABLET100452555.55600Replenished 1001803996
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011267 MR002830170002/17/202102/17/202102/18/202100591024001LORAZEPAM 0.5 MG TABLET0.5 MGTABLET1004040100.00000Replenished 1001826768 3050065355
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011323 MR000513180003/12/202103/12/202103/13/202100591024001LORAZEPAM 0.5 MG TABLET0.5 MGTABLET1002020100.00000Replenished 1001826768 3050065355