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 000000776626 MR000743730704/13/202104/13/202105/06/202127808015701ROSUVASTATIN CALCIUM 20 MG TAB20 MGTABLET903030100.00000Replenished 1001858827 3055792360
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776626 MR000743730805/13/202105/13/202105/14/202127808015701ROSUVASTATIN CALCIUM 20 MG TAB20 MGTABLET90301033.33300Replenished 1001864375 3056859295
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776626 MR000743730805/13/202105/13/202105/14/202127808015701ROSUVASTATIN CALCIUM 20 MG TAB20 MGTABLET90302066.66700Replenished 1001858827 3055792360
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776626 MR000743730906/08/202106/08/202106/09/202127808015701ROSUVASTATIN CALCIUM 20 MG TAB20 MGTABLET903030100.00000Replenished 1001875545 3059020609
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776626 MR000743731007/13/202107/13/202107/14/202127808015701ROSUVASTATIN CALCIUM 20 MG TAB20 MGTABLET903030100.00000Replenished 1001890275 3061781565
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776626 MR000743731108/13/202108/13/202108/14/202127808015701ROSUVASTATIN CALCIUM 20 MG TAB20 MGTABLET903030100.00000Replenished 1001908104 3065555058
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779013 MR000353890001/05/202101/05/202101/06/202127808015701ROSUVASTATIN CALCIUM 20 MG TAB20 MGTABLET90901011.11100Replenished 1001816393 987952822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779013 MR000353890001/05/202101/05/202101/06/202127808015701ROSUVASTATIN CALCIUM 20 MG TAB20 MGTABLET90908088.88900Replenished 1001791001
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779197 MR001584550001/14/202101/14/202101/15/202127808015701ROSUVASTATIN CALCIUM 20 MG TAB20 MGTABLET903030100.00000Replenished 1001816393 987952822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779197 MR001584550102/18/202102/18/202102/19/202127808015701ROSUVASTATIN CALCIUM 20 MG TAB20 MGTABLET903030100.00000Replenished 1001816393 987952822