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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 000000776011 MR003614600303/08/202103/08/202103/09/202133342010207MONTELUKAST SOD 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001823796 3049396293
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777795 MR000985750204/21/202104/21/202104/22/202133342010207MONTELUKAST SOD 10 MG TABLET10 MGTABLET30903033.33300Replenished 1001846719 3053644954
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777795 MR000985750204/21/202104/21/202104/22/202133342010207MONTELUKAST SOD 10 MG TABLET10 MGTABLET30903033.33300Replenished 1001846719 3053644954
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777795 MR000985750204/21/202104/21/202104/22/202133342010207MONTELUKAST SOD 10 MG TABLET10 MGTABLET30903033.33400Replenished 1001846719 3053644954
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778756 MR003928040303/17/202103/17/202103/18/202133342010207MONTELUKAST SOD 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001828208 3050330142
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778756 MR003928040404/19/202104/19/202104/20/202133342010207MONTELUKAST SOD 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001845547 3053392934
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778756 MR003928040505/17/202105/17/202105/18/202133342010207MONTELUKAST SOD 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001860456 3056066373
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778756 MR003928041010/04/202110/04/202110/05/202133342010207MONTELUKAST SOD 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001935866 3069727219
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778756 MR003928041111/29/202111/29/202111/30/202133342010207MONTELUKAST SOD 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001965091 3075301281
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779415 MR002937890203/26/202103/26/202103/28/202133342010207MONTELUKAST SOD 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001833661 3051191521