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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 000000786919 MR002684010206/03/202206/03/202206/04/202243547042309LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET90903033.33300Replenished 1002086492 3101518230
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786919 MR002684010206/03/202206/03/202206/04/202243547042309LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET90906066.66700Replenished 1002062399 3095062965
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786919 MR002684010309/14/202209/14/202209/15/202243547042309LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET90906066.66700Replenished 1002107975 3106203792
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789452 MR000171950105/06/202205/06/202205/07/202243547042309LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET903030100.00000Replenished 1002062399 3095062965
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789452 MR000171950206/08/202206/08/202206/09/202243547042309LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET903030100.00000Replenished 1002086492 3101518230
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789819 MR002771770004/26/202204/26/202204/27/202243547042309LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET909090100.00000Replenished 1002043399 3091212807
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791894 MR002771770008/01/202208/01/202208/02/202243547042309LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET90903033.33300Replenished 1002086492 3101518230
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791894 MR002771770008/01/202208/01/202208/02/202243547042309LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET90906066.66700Replenished 1002088256 3102157587
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791894 MR002771770111/01/202211/01/202211/02/202243547042309LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET90903033.33300Replenished 1002128232 3111347420
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791894 MR002771770111/01/202211/01/202211/02/202243547042309LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET90906066.66700Replenished 1002136666 3112767814