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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 000000781753 MR001393520005/06/202105/06/202105/07/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET12301136.66700Replenished 1001865893 3057164796
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781753 MR001393520005/06/202105/06/202105/07/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET12301033.33300Replenished 1001854421 3055134799
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781753 MR001393520005/06/202105/06/202105/07/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1230930.00000Replenished 1001854421 3055134799
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780940 MR001011130004/01/202104/01/202104/02/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1244100.00000Replenished 1001850290 3054303929
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782925 MR000620750006/28/202106/28/202106/29/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET127457.14300Replenished 1001891615 3062304712
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783053 MR001697170007/02/202107/02/202107/03/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1244100.00000Replenished 1001891615 3062304712
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783437 MR000620750007/20/202107/20/202107/21/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET127457.14300Replenished 1001891615 3062304712
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780016 MR003284060002/19/202102/19/202102/20/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1233100.00000Replenished 1001816393 987952822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780940 MR001011130104/28/202104/28/202104/29/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET124375.00000Replenished 1001850290 3054303929
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782925 MR000620750006/28/202106/28/202106/29/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET127342.85700Replenished 1001882607 3060033992