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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 000000779084 MR001013110310/12/202110/12/202110/13/202129300035001ALLOPURINOL 300 MG TABLET300 MGTABLET100902022.22200Replenished 1002040320 3090640343
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779084 MR001013110310/12/202110/12/202110/13/202129300035001ALLOPURINOL 300 MG TABLET300 MGTABLET100907077.77800Replenished 1001939387 3070573301
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779099 MR000952170708/19/202108/19/202108/20/202129300035001ALLOPURINOL 300 MG TABLET300 MGTABLET100301033.33300Replenished 1001906487 3065291855
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779099 MR000952170708/19/202108/19/202108/20/202129300035001ALLOPURINOL 300 MG TABLET300 MGTABLET100302066.66700Replenished 1001923771 3067867836
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779099 MR000952170809/16/202109/16/202109/17/202129300035001ALLOPURINOL 300 MG TABLET300 MGTABLET1003030100.00000Replenished 1001935094 3069471044
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779099 MR000952170910/14/202110/14/202110/15/202129300035001ALLOPURINOL 300 MG TABLET300 MGTABLET1003030100.00000Replenished 1002040320 3090640343
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781409 MR001174460109/15/202109/15/202109/16/202129300035001ALLOPURINOL 300 MG TABLET300 MGTABLET100301033.33300Replenished 1001935094 3069471044
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781409 MR001174460109/15/202109/15/202109/16/202129300035001ALLOPURINOL 300 MG TABLET300 MGTABLET100302066.66700Replenished 1001923771 3067867836
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781409 MR001174460210/18/202110/18/202110/19/202129300035001ALLOPURINOL 300 MG TABLET300 MGTABLET1003030100.00000Replenished 1002040320 3090640343
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783433 MR000551480007/20/202107/20/202107/21/202129300035001ALLOPURINOL 300 MG TABLET300 MGTABLET1003030100.00000Replenished 1001906487 3065291855