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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 000000774988 MR002109290201/27/202101/27/202101/28/202116729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET100901011.11100Replenished 1001802698
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774988 MR002109290201/27/202101/27/202101/28/202116729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET100901011.11100Replenished 1001825446 3049810902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774988 MR002109290201/27/202101/27/202101/28/202116729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET100907077.77800Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777085 MR000418240302/11/202102/11/202102/12/202116729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET1003030100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780459 MR000418240003/11/202103/11/202103/12/202116729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET1009090100.00000Replenished 1001825446 3049810902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774988 MR002109290305/24/202105/24/202105/25/202116729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET1009090100.00000Replenished 1001872170 3058237732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780459 MR000418240106/09/202106/09/202106/10/202116729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET100901011.11100Replenished 1001872170 3058237732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780459 MR000418240106/09/202106/09/202106/10/202116729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET100908088.88900Replenished 1001919113 3067013098
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783447 MR001613010007/20/202107/20/202107/21/202116729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET1001414100.00000Replenished 1001919113 3067013098
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780459 MR000418240209/07/202109/07/202109/08/202116729017101AMITRIPTYLINE HCL 10 MG TAB10 MGTABLET1009090100.00000Replenished 1001919113 3067013098