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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 000000792773 MR002109290112/01/202212/01/202212/03/202216729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET100907482.22200Replenished 1002155556 3118088750
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793838 MR002304270212/29/202212/29/202201/01/202316729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET100602643.33300Replenished 1002155556 3118088750
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792773 MR002109290112/01/202212/01/202212/03/202216729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET100901617.77800Replenished 1002142782 3114755273
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793838 MR002304270111/26/202211/26/202211/27/202216729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET1006060100.00000Replenished 1002142782 3114755273
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794319 MR000418240011/18/202211/18/202211/19/202216729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET100902426.66700Replenished 1002142782 3114755273
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793838 MR002304270010/28/202210/28/202210/29/202216729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET100603456.66700Replenished 1002137939 3113250053
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794319 MR000418240011/18/202211/18/202211/19/202216729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET100906673.33300Replenished 1002137939 3113250053
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792773 MR002109290009/08/202209/08/202209/10/202216729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET100907482.22200Replenished 1002127559 3110896806
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793838 MR002304270010/28/202210/28/202210/29/202216729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET100602643.33300Replenished 1002127559 3110896806
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792438 MR000418240008/25/202208/25/202208/26/202216729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET100908493.33300Replenished 1002102488 3105614645