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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 000000793297 MR003894840304/24/202304/24/202304/25/202359651042601SPIRONOLACTONE 25 MG TABLET25 MGTABLET100601016.66700Replenished05/02/2023 1002210717 3131427601
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793297 MR003894840304/24/202304/24/202304/25/202359651042601SPIRONOLACTONE 25 MG TABLET25 MGTABLET100605083.33300Replenished08/18/2023 1002260285 3143898442
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000796291 MR001954630002/23/202302/23/202302/24/202359651042601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished05/02/2023 1002210717 3131427601
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000796291 MR001954630103/22/202303/22/202303/23/202359651042601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished05/02/2023 1002210717 3131427601
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000796291 MR001954630204/21/202304/21/202304/22/202359651042601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished05/02/2023 1002210717 3131427601
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000798110 MR001954630005/23/202305/23/202305/24/202359651042601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished08/18/2023 1002260285 3143898442
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000798110 MR001954630106/20/202306/20/202306/21/202359651042601SPIRONOLACTONE 25 MG TABLET25 MGTABLET100302066.66700Replenished08/18/2023 1002260285 3143898442