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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 000000786547 MR002793580112/23/202112/23/202112/24/202160505014100GLIPIZIDE 5 MG TABLET5 MGTABLET1006060100.00000Replenished 1001978209 3078024705
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786547 MR002793580011/29/202111/29/202111/30/202160505014100GLIPIZIDE 5 MG TABLET5 MGTABLET100602033.33300Replenished 1001965091 3075301281
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786547 MR002793580011/29/202111/29/202111/30/202160505014100GLIPIZIDE 5 MG TABLET5 MGTABLET100604066.66700Replenished 1001978209 3078024705
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781484 4900206/28/202106/28/202106/29/202160505014100GLIPIZIDE 5 MG TABLET5 MGTABLET1003030100.00000Replenished 1001965091 3075301281
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778085 MR002793580106/09/202106/09/202106/10/202160505014100GLIPIZIDE 5 MG TABLET5 MGTABLET1001803016.66700Replenished 1001872170 3058237732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778085 MR002793580106/09/202106/09/202106/10/202160505014100GLIPIZIDE 5 MG TABLET5 MGTABLET1001805027.77700Replenished 1001965091 3075301281
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778085 MR002793580106/09/202106/09/202106/10/202160505014100GLIPIZIDE 5 MG TABLET5 MGTABLET10018010055.55600Replenished 1001872170 3058237732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781484 4900106/01/202106/01/202106/02/202160505014100GLIPIZIDE 5 MG TABLET5 MGTABLET1003030100.00000Replenished 1001872170 3058237732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781939 MR004025660005/14/202105/14/202105/15/202160505014100GLIPIZIDE 5 MG TABLET5 MGTABLET1003030100.00000Replenished 1001872170 3058237732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781484 4900004/26/202104/26/202104/27/202160505014100GLIPIZIDE 5 MG TABLET5 MGTABLET100301033.33300Replenished 1001872170 3058237732