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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 000000785815 MR001513540403/03/202203/03/202203/04/202224979002607DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H903030100.00000Replenished 1002102488 3105614645
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790421 MR000186700409/21/202209/21/202209/22/202224979002607DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H903030100.00000Replenished 1002109739 3106973147
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792608 MR002183130009/01/202209/01/202209/02/202224979002607DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H903030100.00000Replenished 1002102488 3105614645
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792795 MR000011310009/08/202209/08/202209/10/202224979002607DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H90903033.33300Replenished 1002102488 3105614645
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792795 MR000011310009/08/202209/08/202209/10/202224979002607DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H90906066.66700Replenished 1002109739 3106973147
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000799785 MR001827140008/17/202308/17/202308/18/202324979002607DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H901809050.00000Replenished08/21/2023 1002260563 3144082982
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000799785 MR001827140008/17/202308/17/202308/18/202324979002607DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H901809050.00000Replenished08/21/2023 1002260563 3144082982