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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 000000787195 MR003195940012/27/202112/28/202112/29/202155111046901METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1002025817 3087713922
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787195 MR003195940101/25/202201/25/202201/26/202255111046901METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1002025817 3087713922
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787195 MR003195940202/23/202202/23/202202/24/202255111046901METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1002025817 3087713922
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787195 MR003195940405/02/202205/02/202205/03/202255111046901METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1002053733 3093649580
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787195 MR003195940506/07/202206/07/202206/08/202255111046901METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1002077322 3098828684
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789371 MR001797270004/05/202204/05/202204/06/202255111046901METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1002053733 3093649580
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789371 MR001797270206/27/202206/27/202206/28/202255111046901METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1002077322 3098828684
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789371 MR001797270307/27/202207/27/202207/28/202255111046901METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1002119084 3108617904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791374 MR003195940007/07/202207/07/202207/08/202255111046901METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1002077322 3098828684
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791374 MR003195940108/08/202208/08/202208/09/202255111046901METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1002119084 3108617904