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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 000000779610 MR001340750002/02/202102/02/202102/03/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET100807695.00000Replenished 1001806279
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779994 129680002/18/202102/18/202102/19/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1003030100.00000Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780189 MR000186700002/25/202102/25/202102/26/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1003030100.00000Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781480 MR000186700004/26/202104/26/202104/27/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1003030100.00000Replenished 1001897048 3062863316
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782229 MR000186700005/26/202105/26/202105/27/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1003030100.00000Replenished 1001897048 3062863316
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782962 MR000186700006/29/202106/29/202106/30/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1003030100.00000Replenished 1001897048 3062863316
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784326 MR000186700008/26/202108/26/202108/27/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1003030100.00000Replenished 1001928804 3069023028
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785006 143780009/23/202109/23/202109/24/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1003030100.00000Replenished 1001928804 3069023028
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785852 MR000186700010/28/202110/28/202110/29/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1003030100.00000Replenished 1001980038 3078339609
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786490 MR000186700011/24/202111/24/202111/25/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1003030100.00000Replenished 1001980038 3078339609