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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 000000777600 MR000105290503/30/202104/01/202104/02/202116729015615SIMVASTATIN 5 MG TABLET5 MGTABLET903030100.00000Replenished 1001868295 3057602223
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777600 MR000105290605/05/202105/05/202105/06/202116729015615SIMVASTATIN 5 MG TABLET5 MGTABLET903030100.00000Replenished 1001868295 3057602223
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777600 MR000105290706/02/202106/02/202106/03/202116729015615SIMVASTATIN 5 MG TABLET5 MGTABLET903030100.00000Replenished 1001868295 3057602223
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777600 MR000105290807/01/202107/01/202107/02/202116729015615SIMVASTATIN 5 MG TABLET5 MGTABLET903030100.00000Replenished 1001917157 3066422605
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777600 MR000105290908/02/202108/02/202108/03/202116729015615SIMVASTATIN 5 MG TABLET5 MGTABLET903030100.00000Replenished 1001917157 3066422605
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777600 MR000105291008/31/202108/31/202109/01/202116729015615SIMVASTATIN 5 MG TABLET5 MGTABLET903030100.00000Replenished 1001917157 3066422605
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777600 MR000105291109/27/202109/27/202109/28/202116729015615SIMVASTATIN 5 MG TABLET5 MGTABLET903030100.00000Replenished 1001965736 3075594883
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785957 MR000105290011/02/202111/02/202111/03/202116729015615SIMVASTATIN 5 MG TABLET5 MGTABLET903030100.00000Replenished 1001965736 3075594883
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785957 MR000105290112/01/202112/01/202112/02/202116729015615SIMVASTATIN 5 MG TABLET5 MGTABLET903030100.00000Replenished 1001965736 3075594883