Back

Accumulator - View By Claim

Export to Excel

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 000000772327 MR002275850401/14/202101/14/202101/15/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET84842833.33300Replenished 1001816056 987916714
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000772327 MR002275850401/14/202101/14/202101/15/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET84845666.66700Replenished 1001796904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780454 MR002395530003/10/202103/10/202103/11/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET848484100.00000Replenished 1001824882 3049647435
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780454 MR002395530105/12/202105/12/202105/13/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET848484100.00000Replenished 1001858287 3055645573
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780454 MR002395530207/20/202107/20/202107/21/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET84842833.33300Replenished 1001891615 3062304712
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780454 MR002395530207/20/202107/20/202107/21/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET84845666.66700Replenished 1001899595 3063713218
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780454 MR002395530309/21/202109/21/202109/22/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET84842833.33300Replenished 1001926498 3068455122
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780454 MR002395530309/21/202109/21/202109/22/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET84845666.66700Replenished 1001936140 3069865653
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786670 MR002395530012/03/202112/03/202112/04/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET84842833.33300Replenished 1001966593 3075785867
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786670 MR002395530012/03/202112/03/202112/04/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET84845666.66700Replenished 1001974643 3077188620