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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 000000781266 MR000418240107/16/202107/16/202107/17/202150816002502METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H1009090100.00000Replenished 1001938284 3070173197
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781266 MR000418240210/08/202110/08/202110/09/202150816002502METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H100901011.11100Replenished 1001938284 3070173197
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781266 MR000418240210/08/202110/08/202110/09/202150816002502METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H100908088.88900Replenished 1001963534 3074872858
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781266 MR000418240301/13/202201/13/202201/14/202250816002502METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H100901011.11100Replenished 1001989515 3080235784
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781266 MR000418240301/13/202201/13/202201/14/202250816002502METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H100908088.88900Replenished 1001991075 3080809434
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786451 MR000272440011/23/202111/23/202111/24/202150816002502METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H100301033.33300Replenished 1001984164 3079004486
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786451 MR000272440011/23/202111/23/202111/24/202150816002502METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H100302066.66700Replenished 1001963534 3074872858
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787075 MR000272440012/21/202112/21/202112/22/202150816002502METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H1003030100.00000Replenished 1001984164 3079004486
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787309 MR002793580012/30/202112/30/202112/31/202150816002502METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H1003030100.00000Replenished 1001984164 3079004486
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787309 MR002793580101/24/202201/24/202201/25/202250816002502METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H1003030100.00000Replenished 1001999272 3082324547