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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 000000787357 MR002109290001/03/202201/03/202201/04/202268382009706PAROXETINE HCL 10 MG TABLET10 MGTABLET30903033.33300Replenished 1001984164 3079004486
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787357 MR002109290001/03/202201/03/202201/04/202268382009706PAROXETINE HCL 10 MG TABLET10 MGTABLET30903033.33300Replenished 1001984164 3079004486
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787357 MR002109290001/03/202201/03/202201/04/202268382009706PAROXETINE HCL 10 MG TABLET10 MGTABLET30903033.33400Replenished 1001984164 3079004486
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787280 MR001455130012/29/202112/29/202112/30/202168382009706PAROXETINE HCL 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001982259 3078646785
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787280 MR001455130101/28/202201/28/202201/29/202268382009706PAROXETINE HCL 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001996462 3081761728
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786731 MR003882130012/06/202112/06/202112/07/202168382009706PAROXETINE HCL 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001969736 3076071583
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786731 MR003882130101/21/202201/21/202201/22/202268382009706PAROXETINE HCL 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001993278 3080996427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786731 MR003882130202/16/202202/16/202202/17/202268382009706PAROXETINE HCL 10 MG TABLET10 MGTABLET303030100.00000Replenished 1002007603 3084006129
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785777 MR003882130010/25/202110/25/202110/26/202168382009706PAROXETINE HCL 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001948371 3071858707
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785661 MR002109290010/20/202110/20/202110/26/202168382009706PAROXETINE HCL 10 MG TABLET10 MGTABLET30903033.33300Replenished 1001948371 3071858707