Back

Accumulator - View By Claim

Export to Excel

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 000000778298 14440102/01/202102/01/202102/02/202159762040101SUCRALFATE 1 GM TABLET1 GTABLET1001203630.00000Replenished 1001836706 3051817902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778298 14440102/01/202102/01/202102/02/202159762040101SUCRALFATE 1 GM TABLET1 GTABLET1001208470.00000Replenished 1001805758
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778298 14440204/02/202104/02/202104/03/202159762040101SUCRALFATE 1 GM TABLET1 GTABLET1001205646.66700Replenished 1001845547 3053392934
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778298 14440204/02/202104/02/202104/03/202159762040101SUCRALFATE 1 GM TABLET1 GTABLET1001206453.33300Replenished 1001836706 3051817902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778298 14440306/03/202106/03/202106/04/202159762040101SUCRALFATE 1 GM TABLET1 GTABLET1001203630.00000Replenished 1001899296 3063578940
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778298 14440306/03/202106/03/202106/04/202159762040101SUCRALFATE 1 GM TABLET1 GTABLET1001208470.00000Replenished 1001868899 3057728019
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781292 18820004/19/202104/19/202104/20/202159762040101SUCRALFATE 1 GM TABLET1 GTABLET100360164.44400Replenished 1001868899 3057728019
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781292 18820004/19/202104/19/202104/20/202159762040101SUCRALFATE 1 GM TABLET1 GTABLET1003604412.22200Replenished 1001845547 3053392934
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781292 18820004/19/202104/19/202104/20/202159762040101SUCRALFATE 1 GM TABLET1 GTABLET10036010027.77800Replenished 1001845547 3053392934
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781292 18820004/19/202104/19/202104/20/202159762040101SUCRALFATE 1 GM TABLET1 GTABLET10036010027.77800Replenished 1001845547 3053392934