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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 000000779812 MR000649240103/11/202103/15/202103/16/202124979002906DILTIAZEM 24H ER(CD) 300 MG CP300 MGCAP.SR 24H303030100.00000Replenished 1001826768 3050065356
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779812 MR000649240204/08/202104/08/202104/09/202124979002906DILTIAZEM 24H ER(CD) 300 MG CP300 MGCAP.SR 24H303030100.00000Replenished 1001839679 3052473904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781813 MR000649240005/10/202105/10/202105/11/202124979002906DILTIAZEM 24H ER(CD) 300 MG CP300 MGCAP.SR 24H303030100.00000Replenished 1001856282 3055381317
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782509 MR000649240006/08/202106/08/202106/09/202124979002906DILTIAZEM 24H ER(CD) 300 MG CP300 MGCAP.SR 24H303030100.00000Replenished 1001871620 3058108728
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782509 MR000649240107/12/202107/12/202107/13/202124979002906DILTIAZEM 24H ER(CD) 300 MG CP300 MGCAP.SR 24H303030100.00000Replenished 1001889250 3061354275
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782509 MR000649240208/09/202108/09/202108/10/202124979002906DILTIAZEM 24H ER(CD) 300 MG CP300 MGCAP.SR 24H303030100.00000Replenished 1001902393 3064140711
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784613 MR000649240009/08/202109/08/202109/09/202124979002906DILTIAZEM 24H ER(CD) 300 MG CP300 MGCAP.SR 24H303030100.00000Replenished 1001921174 3067195910
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785413 MR000649240010/11/202110/11/202110/12/202124979002906DILTIAZEM 24H ER(CD) 300 MG CP300 MGCAP.SR 24H303030100.00000Replenished 1001939012 3070433439
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786218 MR000649240011/15/202111/15/202111/16/202124979002906DILTIAZEM 24H ER(CD) 300 MG CP300 MGCAP.SR 24H303030100.00000Replenished 1001959681 3074009069
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786862 MR000649240012/13/202112/13/202112/14/202124979002906DILTIAZEM 24H ER(CD) 300 MG CP300 MGCAP.SR 24H303030100.00000Replenished 1001973568 3076863124