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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 000000773690 MR000975870502/08/202102/08/202102/09/202116729017301AMITRIPTYLINE HCL 50 MG TAB50 MGTABLET1003030100.00000Replenished 1001821238 3048978888
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000773690 MR000975870603/03/202103/03/202103/04/202116729017301AMITRIPTYLINE HCL 50 MG TAB50 MGTABLET100301033.33300Replenished 1001821238 3048978888
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000773690 MR000975870603/03/202103/03/202103/04/202116729017301AMITRIPTYLINE HCL 50 MG TAB50 MGTABLET100302066.66700Replenished 1001836706 3051817902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000773690 MR000975870704/02/202104/02/202104/03/202116729017301AMITRIPTYLINE HCL 50 MG TAB50 MGTABLET100301033.33300Replenished 1001848263 3053810034
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000773690 MR000975870704/02/202104/02/202104/03/202116729017301AMITRIPTYLINE HCL 50 MG TAB50 MGTABLET100302066.66700Replenished 1001836706 3051817902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775270 MR003248850304/23/202104/23/202104/24/202116729017301AMITRIPTYLINE HCL 50 MG TAB50 MGTABLET100903033.33300Replenished 1001848263 3053810034
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775270 MR003248850304/23/202104/23/202104/24/202116729017301AMITRIPTYLINE HCL 50 MG TAB50 MGTABLET100906066.66700Replenished 1001861596 3056318148
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780165 MR001091850002/24/202102/25/202102/26/202116729017301AMITRIPTYLINE HCL 50 MG TAB50 MGTABLET1006060100.00000Replenished 1001821238 3048978888
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780805 MR001091850003/26/202103/26/202103/28/202116729017301AMITRIPTYLINE HCL 50 MG TAB50 MGTABLET1006060100.00000Replenished 1001836706 3051817902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780805 MR001091850104/21/202104/21/202104/22/202116729017301AMITRIPTYLINE HCL 50 MG TAB50 MGTABLET1006060100.00000Replenished 1001848263 3053810034