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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 000000779015 129680001/05/202101/05/202101/06/202168001024604ONDANSETRON ODT 4 MG TABLET4 MGTAB RAPDIS3020945.00000Replenished 1001791001
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779015 129680001/05/202101/05/202101/06/202168001024604ONDANSETRON ODT 4 MG TABLET4 MGTAB RAPDIS30201155.00000Replenished 1001825446 3049810902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780489 MR000443660003/11/202103/11/202103/12/202168001024604ONDANSETRON ODT 4 MG TABLET4 MGTAB RAPDIS30451942.22200Replenished 1001825446 3049810902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780489 MR000443660003/11/202103/11/202103/12/202168001024604ONDANSETRON ODT 4 MG TABLET4 MGTAB RAPDIS30452657.77800Replenished 1001827193 3050193216
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780569 MR002028490003/16/202103/16/202103/17/202168001024604ONDANSETRON ODT 4 MG TABLET4 MGTAB RAPDIS3010440.00000Replenished 1001827193 3050193216
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780569 MR002028490003/16/202103/16/202103/17/202168001024604ONDANSETRON ODT 4 MG TABLET4 MGTAB RAPDIS3010660.00000Replenished 1001836082 3051817901
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780945 MR002897470004/01/202104/01/202104/02/202168001024604ONDANSETRON ODT 4 MG TABLET4 MGTAB RAPDIS3030620.00000Replenished 1001853845 3055068759
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780945 MR002897470004/01/202104/01/202104/02/202168001024604ONDANSETRON ODT 4 MG TABLET4 MGTAB RAPDIS30302480.00000Replenished 1001836082 3051817901
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781702 MR002484860005/05/202105/05/202105/06/202168001024604ONDANSETRON ODT 4 MG TABLET4 MGTAB RAPDIS3060610.00000Replenished 1001856282 3055381317
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781702 MR002484860005/05/202105/05/202105/06/202168001024604ONDANSETRON ODT 4 MG TABLET4 MGTAB RAPDIS30602440.00000Replenished 1001853845 3055068759