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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 000004011400 MR002793580004/19/202104/19/202104/20/202160505252603MODAFINIL 100 MG TABLET100 MGTABLET30903033.33300Replenished 1001845547 3053392933
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011400 MR002793580004/19/202104/19/202104/20/202160505252603MODAFINIL 100 MG TABLET100 MGTABLET30903033.33300Replenished 1001845547 3053392933
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011400 MR002793580004/19/202104/19/202104/20/202160505252603MODAFINIL 100 MG TABLET100 MGTABLET30903033.33400Replenished 1001845547 3053392933
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011564 MR002793580006/30/202106/30/202107/01/202160505252603MODAFINIL 100 MG TABLET100 MGTABLET301203025.00000Replenished 1001883742 3060343038
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011564 MR002793580006/30/202106/30/202107/01/202160505252603MODAFINIL 100 MG TABLET100 MGTABLET301203025.00000Replenished 1001883742 3060343038
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011564 MR002793580006/30/202106/30/202107/01/202160505252603MODAFINIL 100 MG TABLET100 MGTABLET301203025.00000Replenished 1001883742 3060343038
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011564 MR002793580006/30/202106/30/202107/01/202160505252603MODAFINIL 100 MG TABLET100 MGTABLET301203025.00000Replenished 1001883742 3060343038
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011564 MR002793580111/08/202111/08/202111/09/202160505252603MODAFINIL 100 MG TABLET100 MGTABLET30603050.00000Replenished 1001956102 3073301293
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011564 MR002793580111/08/202111/08/202111/09/202160505252603MODAFINIL 100 MG TABLET100 MGTABLET30603050.00000Replenished 1001956102 3073301293
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011564 MR002793580212/23/202112/23/202112/24/202160505252603MODAFINIL 100 MG TABLET100 MGTABLET30603050.00000Replenished 1001978209 3078024704