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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 000000783667 MR000684920007/30/202107/30/202107/31/202131722077701ACYCLOVIR 400 MG TABLET400 MGTABLET1006060100.00000Replenished 1001951026 3072312986
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785863 MR000684920010/28/202110/28/202110/29/202131722077701ACYCLOVIR 400 MG TABLET400 MGTABLET100604066.66700Replenished 1001951026 3072312986
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793209 MR001455130009/30/202209/30/202210/01/202231722077701ACYCLOVIR 400 MG TABLET400 MGTABLET1002121100.00000Replenished04/12/2023 1002200467 3129734792
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794092 MR001455130011/09/202211/09/202211/10/202231722077701ACYCLOVIR 400 MG TABLET400 MGTABLET1002121100.00000Replenished04/12/2023 1002200467 3129734792
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795158 MR001455130012/30/202212/30/202201/01/202331722077701ACYCLOVIR 400 MG TABLET400 MGTABLET1002121100.00000Replenished04/12/2023 1002200467 3129734792
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795685 MR001455130001/25/202301/25/202301/26/202331722077701ACYCLOVIR 400 MG TABLET400 MGTABLET1002121100.00000Replenished04/12/2023 1002200467 3129734792
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795685 MR001455130104/10/202304/10/202304/11/202331722077701ACYCLOVIR 400 MG TABLET400 MGTABLET100211676.19000Replenished04/12/2023 1002200467 3129734792