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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 000000786590 MR001405940208/15/202208/15/202208/16/202250742024890DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H909090100.00000Replenished 1002096363 3103699608
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786590 MR001405940311/11/202211/11/202211/12/202250742024890DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H90903033.33300Replenished 1002138660 3113575596
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786590 MR001405940311/11/202211/11/202211/12/202250742024890DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H90906066.66700Replenished 1002131051 3112454558
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790421 MR000186700510/24/202210/24/202210/25/202250742024890DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H903030100.00000Replenished 1002125076 3110431983
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790421 MR000186700611/22/202211/22/202211/23/202250742024890DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H903030100.00000Replenished 1002143871 3115454488
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790421 MR000186700712/23/202212/23/202212/24/202250742024890DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H903030100.00000Replenished 1002152667 3117383035
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790421 MR000186700801/24/202301/24/202301/25/202350742024890DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H903030100.00000Replenished 1002178117 3123055057
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790421 MR000186700902/23/202302/23/202302/24/202350742024890DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H903030100.00000Replenished 1002186410 3126119732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790421 MR000186701003/27/202303/27/202303/28/202350742024890DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H903030100.00000Replenished 1002197595 3128646478
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790421 MR000186701104/25/202304/25/202304/26/202350742024890DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H903030100.00000Replenished05/22/2023 1002222095 3134071095