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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 000000784604 MR000860360009/07/202109/07/202109/08/202168001032104BUPROPION HCL XL 300 MG TABLET300 MGTAB.SR 24H303030100.00000Replenished 1001428666
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784604 MR000860360110/18/202110/18/202110/19/202168001032104BUPROPION HCL XL 300 MG TABLET300 MGTAB.SR 24H303030100.00000Replenished 1001945251 3071148263
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784604 MR000860360212/06/202112/06/202112/07/202168001032104BUPROPION HCL XL 300 MG TABLET300 MGTAB.SR 24H303030100.00000Replenished 1001969736 3076071583
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784926 MR003139190009/20/202109/20/202109/21/202168001032104BUPROPION HCL XL 300 MG TABLET300 MGTAB.SR 24H303030100.00000Replenished 1001925175 3068316933
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784926 MR003139190110/15/202110/15/202110/16/202168001032104BUPROPION HCL XL 300 MG TABLET300 MGTAB.SR 24H303030100.00000Replenished 1001951026 3072312986
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786345 MR003139190011/18/202111/18/202111/19/202168001032104BUPROPION HCL XL 300 MG TABLET300 MGTAB.SR 24H303030100.00000Replenished 1001962155 3074468468
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787665 MR000860360001/14/202201/14/202201/15/202268001032104BUPROPION HCL XL 300 MG TABLET300 MGTAB.SR 24H303030100.00000Replenished 1001989825 3080235785
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787665 MR000860360102/14/202202/14/202202/16/202268001032104BUPROPION HCL XL 300 MG TABLET300 MGTAB.SR 24H303030100.00000Replenished 1002006990 3083681811