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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 000000780882 MR000272440310/26/202110/26/202110/27/202168001039700FAMOTIDINE 20 MG TABLET20 MGTABLET1006060100.00000Replenished 1001961629 3074284779
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785124 MR002897470110/28/202110/28/202110/29/202168001039700FAMOTIDINE 20 MG TABLET20 MGTABLET1003030100.00000Replenished 1001961629 3074284779
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786297 MR000303240011/17/202111/17/202111/18/202168001039700FAMOTIDINE 20 MG TABLET20 MGTABLET100301033.33300Replenished 1001961629 3074284779
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786297 MR000303240011/17/202111/17/202111/18/202168001039700FAMOTIDINE 20 MG TABLET20 MGTABLET100302066.66700Replenished 1001963244 3074735172
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784361 MR002484860211/22/202111/22/202111/23/202168001039700FAMOTIDINE 20 MG TABLET20 MGTABLET1006060100.00000Replenished 1001963244 3074735172
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785124 MR002897470211/22/202111/22/202111/23/202168001039700FAMOTIDINE 20 MG TABLET20 MGTABLET100301033.33300Replenished 1001986240 3079460588
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785124 MR002897470211/22/202111/22/202111/23/202168001039700FAMOTIDINE 20 MG TABLET20 MGTABLET100302066.66700Replenished 1001963244 3074735172
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786951 MR000303240012/16/202112/16/202112/17/202168001039700FAMOTIDINE 20 MG TABLET20 MGTABLET1003030100.00000Replenished 1001986240 3079460588
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785124 MR002897470312/24/202112/24/202112/25/202168001039700FAMOTIDINE 20 MG TABLET20 MGTABLET1003030100.00000Replenished 1001986240 3079460588
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787462 MR002484860001/06/202201/06/202201/07/202268001039700FAMOTIDINE 20 MG TABLET20 MGTABLET100603050.00000Replenished 1001986240 3079460588