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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 000000773599 MR001193700102/22/202102/22/202102/23/202160505082901FLUTICASONE PROP 50 MCG SPRAY50 MCGSPRAY SUSP1616850.00000Replenished 1001816056 987916714
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000773599 MR001193700102/22/202102/22/202102/23/202160505082901FLUTICASONE PROP 50 MCG SPRAY50 MCGSPRAY SUSP1616850.00000Replenished 1001816393 987952822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774672 MR000929910206/28/202106/28/202106/29/202160505082901FLUTICASONE PROP 50 MCG SPRAY50 MCGSPRAY SUSP1616850.00000Replenished 1001882607 3060033992
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774672 MR000929910206/28/202106/28/202106/29/202160505082901FLUTICASONE PROP 50 MCG SPRAY50 MCGSPRAY SUSP1616850.00000Replenished 1001884259 3060456965
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774684 MR001114510302/05/202102/05/202102/06/202160505082901FLUTICASONE PROP 50 MCG SPRAY50 MCGSPRAY SUSP1616850.00000Replenished 1001807887
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774684 MR001114510302/05/202102/05/202102/06/202160505082901FLUTICASONE PROP 50 MCG SPRAY50 MCGSPRAY SUSP1616850.00000Replenished 1001811909 987581092
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775576 MR001881110302/18/202102/18/202102/19/202160505082901FLUTICASONE PROP 50 MCG SPRAY50 MCGSPRAY SUSP161616100.00000Replenished 1001814475 987756775
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777507 MR003928040302/17/202102/17/202102/18/202160505082901FLUTICASONE PROP 50 MCG SPRAY50 MCGSPRAY SUSP1616850.00000Replenished 1001812276 987651857
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777507 MR003928040302/17/202102/17/202102/18/202160505082901FLUTICASONE PROP 50 MCG SPRAY50 MCGSPRAY SUSP1616850.00000Replenished 1001814475 987756775
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777507 MR003928040404/19/202104/19/202104/20/202160505082901FLUTICASONE PROP 50 MCG SPRAY50 MCGSPRAY SUSP1616850.00000Replenished 1001845547 3053392934