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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 000000778649 39200012/17/202012/17/202012/18/202057237007530ONDANSETRON HCL 4 MG TABLET4 MGTABLET3010550.00000Replenished 1001780016
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778649 39200012/17/202012/17/202012/18/202057237007530ONDANSETRON HCL 4 MG TABLET4 MGTABLET3010550.00000Replenished 1001838628 3052278967
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780271 MR002527360003/02/202103/02/202103/03/202157237007530ONDANSETRON HCL 4 MG TABLET4 MGTABLET302020100.00000Replenished 1001838628 3052278967
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781003 MR002187830004/05/202104/05/202104/07/202157237007530ONDANSETRON HCL 4 MG TABLET4 MGTABLET3010550.00000Replenished 1001838628 3052278967
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781003 MR002187830004/05/202104/05/202104/07/202157237007530ONDANSETRON HCL 4 MG TABLET4 MGTABLET3010550.00000Replenished 1001858287 3055645573
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781819 MR002142010005/11/202105/11/202105/12/202157237007530ONDANSETRON HCL 4 MG TABLET4 MGTABLET302020100.00000Replenished 1001858287 3055645573
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781881 MR000380130005/12/202105/12/202105/13/202157237007530ONDANSETRON HCL 4 MG TABLET4 MGTABLET3030516.66700Replenished 1001858287 3055645573
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781881 MR000380130005/12/202105/12/202105/13/202157237007530ONDANSETRON HCL 4 MG TABLET4 MGTABLET30302583.33300Replenished 1001862702 3056474257
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782103 MR001520150005/21/202105/21/202105/22/202157237007530ONDANSETRON HCL 4 MG TABLET4 MGTABLET3028517.85700Replenished 1001862702 3056474257
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782103 MR001520150005/21/202105/21/202105/22/202157237007530ONDANSETRON HCL 4 MG TABLET4 MGTABLET30282382.14300Replenished 1001945703 3071287759