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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 000000794295 MR002717900011/17/202211/17/202211/18/202260429011301METFORMIN HCL 1,000 MG TABLET1000 MGTABLET1006060100.00000Replenished 1002155556 3118088750
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794295 MR002717900112/31/202212/31/202201/01/202360429011301METFORMIN HCL 1,000 MG TABLET1000 MGTABLET100602033.33300Replenished 1002196370 3128329091
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794295 MR002717900112/31/202212/31/202201/01/202360429011301METFORMIN HCL 1,000 MG TABLET1000 MGTABLET100604066.66700Replenished 1002155556 3118088750
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794295 MR002717900202/16/202302/16/202302/17/202360429011301METFORMIN HCL 1,000 MG TABLET1000 MGTABLET1006060100.00000Replenished 1002196370 3128329091
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794295 MR002717900303/28/202303/28/202303/29/202360429011301METFORMIN HCL 1,000 MG TABLET1000 MGTABLET100602033.33300Replenished 1002196370 3128329091
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794295 MR002717900303/28/202303/28/202303/29/202360429011301METFORMIN HCL 1,000 MG TABLET1000 MGTABLET100604066.66700Replenished05/30/2023 1002225063 3134923126
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794295 MR002717900405/15/202305/15/202305/16/202360429011301METFORMIN HCL 1,000 MG TABLET1000 MGTABLET1006060100.00000Replenished05/30/2023 1002225063 3134923126