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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 000000782364 MR000606040702/23/202202/23/202202/24/202200003089421ELIQUIS 5 MG TABLET5 MGTABLET606060100.00000Replenished 1002010793 3084577185
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787337 MR001024640102/01/202202/01/202202/02/202200003089421ELIQUIS 5 MG TABLET5 MGTABLET60602033.33300Replenished 1002010793 3084577185
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788518 MR002091460002/23/202202/23/202202/24/202200003089421ELIQUIS 5 MG TABLET5 MGTABLET60604066.66700Replenished 1002010793 3084577185
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782364 MR000606040601/25/202201/25/202201/26/202200003089421ELIQUIS 5 MG TABLET5 MGTABLET60602033.33300Replenished 1001998721 3082187336
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785235 MR001709230302/01/202202/01/202202/02/202200003089421ELIQUIS 5 MG TABLET5 MGTABLET606060100.00000Replenished 1001998721 3082187336
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787337 MR001024640102/01/202202/01/202202/02/202200003089421ELIQUIS 5 MG TABLET5 MGTABLET60604066.66700Replenished 1001998721 3082187336
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782364 MR000606040601/25/202201/25/202201/26/202200003089421ELIQUIS 5 MG TABLET5 MGTABLET60604066.66700Replenished 1001994779 3081424825
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783838 MR000952170501/20/202201/20/202201/22/202200003089421ELIQUIS 5 MG TABLET5 MGTABLET60602033.33300Replenished 1001994779 3081424825
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783838 MR000952170501/20/202201/20/202201/22/202200003089421ELIQUIS 5 MG TABLET5 MGTABLET60604066.66700Replenished 1001993278 3080996427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787794 MR002091460001/20/202201/20/202201/21/202200003089421ELIQUIS 5 MG TABLET5 MGTABLET60602033.33300Replenished 1001993278 3080996427