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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 000000783480 MR002290390007/21/202107/21/202107/22/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100904550.00000Replenished 1001903117 3064415063
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783961 MR000557370008/11/202108/11/202108/12/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET1006058.33300Replenished 1001918470 3066738110
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783961 MR000557370008/11/202108/11/202108/12/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100605591.66700Replenished 1001903117 3064415063
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783961 MR000557370109/07/202109/07/202109/08/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100602541.66700Replenished 1001919113 3067013098
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783961 MR000557370109/07/202109/07/202109/08/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100603558.33300Replenished 1001952427 3072856896
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785291 MR000557370010/05/202110/05/202110/06/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET1006060100.00000Replenished 1001952427 3072856896
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785291 MR000557370111/03/202111/03/202111/04/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET1006058.33300Replenished 1001952427 3072856896
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785291 MR000557370111/03/202111/03/202111/04/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100605591.66700Replenished 1001965736 3075594883
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785291 MR000557370212/01/202112/01/202112/02/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100601525.00000Replenished 1001965736 3075594883
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785291 MR000557370212/01/202112/01/202112/02/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100604575.00000Replenished 1001966593 3075785867