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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 000000783754 MR001114510008/03/202108/03/202108/04/202168001036104MONTELUKAST SOD 10 MG TABLET10 MGTABLET30903033.33300Replenished 1001899296 3063578940
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783754 MR001114510008/03/202108/03/202108/04/202168001036104MONTELUKAST SOD 10 MG TABLET10 MGTABLET30903033.33300Replenished 1001899296 3063578940
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783754 MR001114510008/03/202108/03/202108/04/202168001036104MONTELUKAST SOD 10 MG TABLET10 MGTABLET30903033.33400Replenished 1001899296 3063578940
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783988 MR000530370008/11/202108/11/202108/12/202168001036104MONTELUKAST SOD 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001903117 3064415063
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784058 MR002091460008/16/202108/16/202108/17/202168001036104MONTELUKAST SOD 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001904997 3064847322
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784244 MR000860360008/23/202108/23/202108/24/202168001036104MONTELUKAST SOD 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001916348 3066127862
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782254 MR002937890308/23/202108/23/202108/24/202168001036104MONTELUKAST SOD 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001916348 3066127862
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789746 MR003891160409/19/202209/19/202209/20/202268001036104MONTELUKAST SOD 10 MG TABLET10 MGTABLET303030100.00000Replenished 1002109182 3106682332
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778756 MR003928040808/09/202108/09/202108/10/202168001036104MONTELUKAST SOD 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001902393 3064140711