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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 000000774512 MR000748341004/16/202104/16/202105/06/202124979002707DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H906060100.00000Replenished 1001853845 3055068759
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774512 MR000748341105/13/202105/13/202105/14/202124979002707DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H906060100.00000Replenished 1001877828 3059333148
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778689 MR000606040103/23/202103/23/202103/25/202124979002707DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H90903033.33300Replenished 1001850989 3054468652
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778689 MR000606040103/23/202103/23/202103/25/202124979002707DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H90906066.66700Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778689 MR000606040206/21/202106/21/202106/22/202124979002707DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H90903033.33300Replenished 1001877828 3059333148
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778689 MR000606040206/21/202106/21/202106/22/202124979002707DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H90906066.66700Replenished 1001899296 3063578940
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778689 MR000606040309/20/202109/20/202109/21/202124979002707DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H90903033.33300Replenished 1001925175 3068316933
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778689 MR000606040309/20/202109/20/202109/21/202124979002707DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H90906066.66700Replenished 1001951777 3072578295
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779554 MR000443660001/29/202101/29/202101/30/202124979002707DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H90903033.33300Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779554 MR000443660001/29/202101/29/202101/30/202124979002707DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H90906066.66700Replenished 1001803996