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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 000000780910 MR000952170003/31/202103/31/202104/01/202176204020060ALBUTEROL SUL 2.5 MG/3 ML SOLN2.5 MG/3MLVIAL-NEB.180180180100.00000Replenished 1001835626 3051655272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780910 MR000952170103/24/202203/24/202203/25/202276204020060ALBUTEROL SUL 2.5 MG/3 ML SOLN2.5 MG/3MLVIAL-NEB.180180180100.00000Replenished 1002025817 3087713922
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785025 MR000380130009/23/202109/23/202109/24/202176204020060ALBUTEROL SUL 2.5 MG/3 ML SOLN2.5 MG/3MLVIAL-NEB.180180180100.00000Replenished 1001927749 3068767552
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787798 MR001520150001/20/202201/20/202201/21/202276204020060ALBUTEROL SUL 2.5 MG/3 ML SOLN2.5 MG/3MLVIAL-NEB.180180180100.00000Replenished 1001916855 3066262939
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787798 MR001520150110/20/202210/20/202210/21/202276204020060ALBUTEROL SUL 2.5 MG/3 ML SOLN2.5 MG/3MLVIAL-NEB.180180180100.00000Replenished 1002124047 3110135014
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787798 MR001520150212/30/202212/30/202201/01/202376204020060ALBUTEROL SUL 2.5 MG/3 ML SOLN2.5 MG/3MLVIAL-NEB.180180180100.00000Replenished 1002155556 3118088750
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794786 MR001265220012/12/202212/12/202212/13/202276204020060ALBUTEROL SUL 2.5 MG/3 ML SOLN2.5 MG/3MLVIAL-NEB.180180180100.00000Replenished 1002149821 3116206380
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000798073 MR000977320005/22/202305/22/202305/23/202376204020060ALBUTEROL SUL 2.5 MG/3 ML SOLN2.5 MG/3MLVIAL-NEB.180180180100.00000Replenished06/05/2023 1002226813 3135522749