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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 000000787850 MR000380130001/24/202201/24/202201/25/202245802016000DICLOFENAC SODIUM 1% GEL1 %GEL (GRAM)100100100100.00000Replenished 1001994028 3081275297
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785781 MR002981580101/18/202201/18/202201/19/202245802016000DICLOFENAC SODIUM 1% GEL1 %GEL (GRAM)10030010033.33300Replenished 1001990723 3080663331
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785781 MR002981580101/18/202201/18/202201/19/202245802016000DICLOFENAC SODIUM 1% GEL1 %GEL (GRAM)10030010033.33300Replenished 1001990723 3080663331
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785781 MR002981580101/18/202201/18/202201/19/202245802016000DICLOFENAC SODIUM 1% GEL1 %GEL (GRAM)10030010033.33400Replenished 1001990723 3080663331
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787556 MR000510590001/11/202201/11/202201/12/202245802016000DICLOFENAC SODIUM 1% GEL1 %GEL (GRAM)100100100100.00000Replenished 1001988537 3079894894
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787254 MR000380130012/28/202112/28/202112/29/202145802016000DICLOFENAC SODIUM 1% GEL1 %GEL (GRAM)100100100100.00000Replenished 1001981624 3078485431
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786706 MR000510590012/06/202112/06/202112/07/202145802016000DICLOFENAC SODIUM 1% GEL1 %GEL (GRAM)100100100100.00000Replenished 1001969736 3076071583
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783930 MR000380130112/02/202112/02/202112/03/202145802016000DICLOFENAC SODIUM 1% GEL1 %GEL (GRAM)100100100100.00000Replenished 1001966028 3075785866
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783930 MR000380130011/16/202111/16/202111/17/202145802016000DICLOFENAC SODIUM 1% GEL1 %GEL (GRAM)100100100100.00000Replenished 1001960301 3074163363
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786111 MR000510590011/08/202111/08/202111/09/202145802016000DICLOFENAC SODIUM 1% GEL1 %GEL (GRAM)100100100100.00000Replenished 1001956102 3073301294