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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 000000780846 MR003981020003/29/202103/29/202103/30/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR10030826.66700Replenished 1001834470 3051403572
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780846 MR003981020003/29/202103/29/202103/30/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100302273.33300Replenished 1001835056 3051528184
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780846 MR003981020105/10/202105/10/202105/11/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1003030100.00000Replenished 1001856282 3055381317
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780846 MR003981020207/10/202107/10/202107/11/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR10030413.33300Replenished 1001888745 3061086533
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780846 MR003981020207/10/202107/10/202107/11/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100302686.66700Replenished 1001889250 3061354275
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780846 MR003981020308/10/202108/10/202108/11/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1003030100.00000Replenished 1001906178 3065115185
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780846 MR003981020409/08/202109/08/202109/09/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR10030413.33300Replenished 1001921174 3067195910
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780846 MR003981020409/08/202109/08/202109/09/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100302686.66700Replenished 1001921962 3067326644
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780846 MR003981020511/01/202111/01/202111/02/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1003030100.00000Replenished 1001952427 3072856896
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780846 MR003981020612/06/202112/06/202112/07/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1003030100.00000Replenished 1001970980 3076395348