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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)Cash 340B 000000786543 MR000215480011/29/202111/29/202111/29/202116729017001ESCITALOPRAM 20 MG TABLET20 MGTABLET100301033.33300Replenished 1001965091 3075301281
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000786543 MR000215480011/29/202111/29/202111/29/202116729017001ESCITALOPRAM 20 MG TABLET20 MGTABLET100302066.66700Replenished 1001984636 3079137424
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000786543 MR000215480103/14/202203/14/202203/14/202216729017001ESCITALOPRAM 20 MG TABLET20 MGTABLET1003030100.00000Replenished 1002020474 3086983191
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777937 MR003086660203/02/202103/02/202103/03/202116729017001ESCITALOPRAM 20 MG TABLET20 MGTABLET1003030100.00000Replenished 1001825446 3049810902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778905 MR000443660101/29/202101/29/202101/30/202116729017001ESCITALOPRAM 20 MG TABLET20 MGTABLET100301033.33300Replenished 1001825446 3049810902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778905 MR000443660101/29/202101/29/202101/30/202116729017001ESCITALOPRAM 20 MG TABLET20 MGTABLET100302066.66700Replenished 1001803996
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778905 MR000443660203/04/202103/04/202103/05/202116729017001ESCITALOPRAM 20 MG TABLET20 MGTABLET1003030100.00000Replenished 1001825446 3049810902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778905 MR000443660304/07/202104/07/202104/08/202116729017001ESCITALOPRAM 20 MG TABLET20 MGTABLET100301033.33300Replenished 1001839075 3052306186
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778905 MR000443660304/07/202104/07/202104/08/202116729017001ESCITALOPRAM 20 MG TABLET20 MGTABLET100302066.66700Replenished 1001871163 3057980095
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778905 MR000443660404/29/202104/29/202104/30/202116729017001ESCITALOPRAM 20 MG TABLET20 MGTABLET1003030100.00000Replenished 1001871163 3057980095