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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 000000783830 MR003883610501/14/202201/14/202201/15/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET10030516.66700Replenished 1001989825 3080235785
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783830 MR003883610501/14/202201/14/202201/15/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET100302583.33300Replenished 1002035636 3089579960
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783830 MR003883610412/13/202112/13/202112/14/202160505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1003030100.00000Replenished 1001989825 3080235785
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783830 MR003883610311/11/202111/11/202111/12/202160505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1003030100.00000Replenished 1001989825 3080235785
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788872 MR003883610306/10/202206/10/202206/11/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET100301033.33300Replenished 1002066046 3095834366
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788872 MR003883610306/10/202206/10/202206/11/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET100302066.66700Replenished 1002102296 3105614642
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791433 MR003883610310/12/202210/12/202210/13/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1003030100.00000Replenished 1002130060 3112131940
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783830 MR003883610210/19/202110/19/202110/20/202160505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1003030100.00000Replenished 1001989825 3080235785
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785594 MR002897470210/03/202210/03/202210/04/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1004545100.00000Replenished 1002130060 3112131940
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788872 MR003883610205/09/202205/09/202205/10/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1003030100.00000Replenished 1002066046 3095834366