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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 000000780510 MR000670640003/12/202103/12/202103/13/202100574200830NYSTOP 100,000 UNIT/GM POWDER100000/GPOWDER303030100.00000Replenished 1001825961 3049810904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781085 MR001943700004/08/202104/08/202104/09/202100574200830NYSTOP 100,000 UNIT/GM POWDER100000/GPOWDER303030100.00000Replenished 1001839679 3052473904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786879 MR002183130012/13/202112/13/202112/14/202100574200830NYSTOP 100,000 UNIT/GM POWDER100000/GPOWDER303030100.00000Replenished 1001973568 3076863124
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787056 MR002856250012/20/202112/20/202112/21/202100574200830NYSTOP 100,000 UNIT/GM POWDER100000/GPOWDER303030100.00000Replenished 1001976721 3077692823
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790054 MR001852200005/05/202205/05/202205/06/202200574200830NYSTOP 100,000 UNIT/GM POWDER100000/GPOWDER303030100.00000Replenished 1002046961 3092154961
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786879 MR002183130102/23/202202/23/202202/24/202200574200830NYSTOP 100,000 UNIT/GM POWDER100000/GPOWDER303030100.00000Replenished 1002010793 3084577185
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786879 MR002183130208/18/202208/18/202208/19/202200574200830NYSTOP 100,000 UNIT/GM POWDER100000/GPOWDER303030100.00000Replenished 1002095338 3103418814
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786879 MR002183130309/15/202209/15/202209/16/202200574200830NYSTOP 100,000 UNIT/GM POWDER100000/GPOWDER303030100.00000Replenished 1002108257 3106376963