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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 000000778832 129680012/28/202012/28/202012/29/202060505025203TIZANIDINE HCL 4 MG TABLET4 MGTABLET1508337.50000Replenished 1001858287 3055645573
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778832 129680012/28/202012/28/202012/29/202060505025203TIZANIDINE HCL 4 MG TABLET4 MGTABLET1508562.50000Replenished 1001785912
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778962 129680001/04/202101/04/202101/05/202160505025203TIZANIDINE HCL 4 MG TABLET4 MGTABLET15088100.00000Replenished 1001858287 3055645573
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780468 MR001613010003/11/202103/11/202103/12/202160505025203TIZANIDINE HCL 4 MG TABLET4 MGTABLET1502020100.00000Replenished 1001858287 3055645573
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780710 MR002937890003/23/202103/23/202103/25/202160505025203TIZANIDINE HCL 4 MG TABLET4 MGTABLET1503030100.00000Replenished 1001858287 3055645573
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780770 MR002937890004/22/202104/22/202104/23/202160505025203TIZANIDINE HCL 4 MG TABLET4 MGTABLET1504242100.00000Replenished 1001858287 3055645573
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780996 MR001613010004/05/202104/05/202104/07/202160505025203TIZANIDINE HCL 4 MG TABLET4 MGTABLET1502020100.00000Replenished 1001858287 3055645573
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781541 MR001613010004/28/202104/28/202104/29/202160505025203TIZANIDINE HCL 4 MG TABLET4 MGTABLET1502020100.00000Replenished 1001858287 3055645573
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781861 MR001613010005/12/202105/12/202105/13/202160505025203TIZANIDINE HCL 4 MG TABLET4 MGTABLET15020735.00000Replenished 1001858287 3055645573
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781861 MR001613010005/12/202105/12/202105/13/202160505025203TIZANIDINE HCL 4 MG TABLET4 MGTABLET150201365.00000Replenished 1001923771 3067867836