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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 000000793952 MR000790050011/02/202211/02/202211/05/202243598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33300Replenished 1002129142 3111671677
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793952 MR000790050011/02/202211/02/202211/05/202243598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33300Replenished 1002129142 3111671677
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793952 MR000790050011/02/202211/02/202211/05/202243598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33400Replenished 1002129142 3111671677
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791915 MR000790050008/02/202208/02/202208/03/202243598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33300Replenished 1002086833 3101665733
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791915 MR000790050008/02/202208/02/202208/03/202243598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33300Replenished 1002086833 3101665733
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791915 MR000790050008/02/202208/02/202208/03/202243598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33400Replenished 1002086833 3101665733
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783622 MR000790050305/02/202205/02/202205/03/202243598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33300Replenished 1002045985 3091824990
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783622 MR000790050305/02/202205/02/202205/03/202243598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33300Replenished 1002045985 3091824990
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783622 MR000790050305/02/202205/02/202205/03/202243598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33400Replenished 1002045985 3091824990
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783622 MR000790050201/31/202201/31/202202/01/202243598050530RALOXIFENE HCL 60 MG TABLET60 MGTABLET30903033.33300Replenished 1001996909 3082044844