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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)Cash 340B 000000787950 MR001838430001/27/202201/27/202201/27/202242806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1002045985 3091824990
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779652 MR003913090002/03/202102/03/202102/05/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100301033.33300Replenished 1001825961 3049810904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779652 MR003913090002/03/202102/03/202102/05/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100302066.66700Replenished 1001807517
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780011 MR002899720002/18/202102/18/202102/19/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001825961 3049810904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780516 MR000378510003/12/202103/12/202103/13/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100903033.33300Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780516 MR000378510003/12/202103/12/202103/13/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100906066.66700Replenished 1001825961 3049810904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780723 MR003913090003/23/202103/23/202103/25/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100902022.22200Replenished 1001852121 3054859692
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780723 MR003913090003/23/202103/23/202103/25/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100907077.77800Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780723 MR003913090106/21/202106/21/202106/22/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100902022.22200Replenished 1001877828 3059333148
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780723 MR003913090106/21/202106/21/202106/22/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100907077.77800Replenished 1001889250 3061354275