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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 000000786824 MR000606040309/16/202209/16/202209/17/202250742024930DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H30903033.33300Replenished 1002108474 3106376964
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786824 MR000606040309/16/202209/16/202209/17/202250742024930DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H30903033.33300Replenished 1002108474 3106376964
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786824 MR000606040309/16/202209/16/202209/17/202250742024930DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H30903033.33400Replenished 1002108474 3106376964
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787183 MR000748340410/03/202210/03/202210/04/202250742024930DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H30603050.00000Replenished 1002114625 3108158138
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787183 MR000748340410/03/202210/03/202210/04/202250742024930DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H30603050.00000Replenished 1002114625 3108158138
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787183 MR000748340511/01/202211/01/202211/02/202250742024930DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H30603050.00000Replenished 1002128232 3111347420
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787183 MR000748340511/01/202211/01/202211/02/202250742024930DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H30603050.00000Replenished 1002128232 3111347420
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787183 MR000748340612/05/202212/05/202212/06/202250742024930DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H30603050.00000Replenished 1002143287 3115100157
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787183 MR000748340612/05/202212/05/202212/06/202250742024930DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H30603050.00000Replenished 1002143287 3115100157
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794734 MR000606040012/08/202212/08/202212/09/202250742024930DILTIAZEM 24H ER(CD) 180 MG CP180 MGCAP.SR 24H30903033.33300Replenished 1002147534 3115655014