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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 000000779726 MR002290390002/08/202102/11/202102/12/202151672128202TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)303030100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779726 MR002290390102/11/202102/11/202102/12/202151672128202TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)303030100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779924 B6VYVWDV5DVD0002/16/202102/16/202102/17/202151672128202TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)303030100.00000Replenished 1001811909 987581092
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779971 MR001650040002/17/202102/17/202102/18/202151672128202TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)303030100.00000Replenished 1001812276 987651857
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781259 MR002807180004/15/202104/15/202104/16/202151672128202TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)303030100.00000Replenished 1001843888 3053146133
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781906 MR003057500005/13/202105/13/202105/14/202151672128202TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)303030100.00000Replenished 1001858827 3055792360
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783990 MR001852200008/11/202108/11/202108/12/202151672128202TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)303030100.00000Replenished 1001903117 3064415063
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783990 MR001852200110/13/202110/13/202110/14/202151672128202TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)303030100.00000Replenished 1001940281 3070884325
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784008 MR000380130008/12/202108/12/202108/13/202151672128202TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)303030100.00000Replenished 1001903497 3064589180
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786861 MR000620750012/13/202112/13/202112/14/202151672128202TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)303030100.00000Replenished 1001976173 3077521516