Back

Accumulator - View By Claim

Export to Excel

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 000000777700 MR000130120201/14/202101/14/202101/15/202162756079788DIVALPROEX SOD DR 250 MG TAB250 MGTABLET DR1001808044.44400Replenished 1001812276 987651857
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777700 MR000130120201/14/202101/14/202101/15/202162756079788DIVALPROEX SOD DR 250 MG TAB250 MGTABLET DR10018010055.55600Replenished 1001796904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777700 MR000130120302/17/202102/17/202102/18/202162756079788DIVALPROEX SOD DR 250 MG TAB250 MGTABLET DR1001802011.11100Replenished 1001812276 987651857
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777700 MR000130120302/17/202102/17/202102/18/202162756079788DIVALPROEX SOD DR 250 MG TAB250 MGTABLET DR1001806033.33300Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777700 MR000130120302/17/202102/17/202102/18/202162756079788DIVALPROEX SOD DR 250 MG TAB250 MGTABLET DR10018010055.55600Replenished 1001812276 987651857
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780666 MR000130120003/22/202103/22/202103/23/202162756079788DIVALPROEX SOD DR 250 MG TAB250 MGTABLET DR1001804022.22200Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780666 MR000130120003/22/202103/22/202103/23/202162756079788DIVALPROEX SOD DR 250 MG TAB250 MGTABLET DR1001804022.22200Replenished 1001845547 3053392934
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780666 MR000130120003/22/202103/22/202103/23/202162756079788DIVALPROEX SOD DR 250 MG TAB250 MGTABLET DR10018010055.55600Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781300 MR000130120004/19/202104/19/202104/20/202162756079788DIVALPROEX SOD DR 250 MG TAB250 MGTABLET DR1001802011.11100Replenished 1001860966 3056169530
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781300 MR000130120004/19/202104/19/202104/20/202162756079788DIVALPROEX SOD DR 250 MG TAB250 MGTABLET DR1001806033.33300Replenished 1001845547 3053392934