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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 000000794541 MR003901320011/29/202211/29/202211/30/202200555901858TRI-SPRINTEC TABLET7DAYSX3 28TABLET1688484100.00000Replenished 1002185066 3125534406
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794541 MR003901320103/04/202303/04/202303/05/202300555901858TRI-SPRINTEC TABLET7DAYSX3 28TABLET1688484100.00000Replenished 1002185066 3125534406
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782796 MR003901320202/16/202202/16/202202/17/202200555901858TRI-SPRINTEC TABLET7DAYSX3 28TABLET1688484100.00000Replenished 1002031572 3088985443
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783712 MR002373390304/05/202204/05/202204/06/202200555901858TRI-SPRINTEC TABLET7DAYSX3 28TABLET1688484100.00000Replenished 1002031572 3088985443
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782796 MR003901320111/15/202111/15/202111/16/202100555901858TRI-SPRINTEC TABLET7DAYSX3 28TABLET1688484100.00000Replenished 1001988537 3079894894
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783712 MR002373390201/11/202201/11/202201/12/202200555901858TRI-SPRINTEC TABLET7DAYSX3 28TABLET1688484100.00000Replenished 1001988537 3079894894
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782796 MR003901320008/09/202108/09/202108/10/202100555901858TRI-SPRINTEC TABLET7DAYSX3 28TABLET1688484100.00000Replenished 1001928804 3069023028
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783712 MR002373390109/27/202109/27/202109/28/202100555901858TRI-SPRINTEC TABLET7DAYSX3 28TABLET1688484100.00000Replenished 1001928804 3069023028
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782415 177180006/04/202106/04/202106/05/202100555901858TRI-SPRINTEC TABLET7DAYSX3 28TABLET1688484100.00000Replenished 1001899045 3063437222
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783712 MR002373390008/02/202108/02/202108/03/202100555901858TRI-SPRINTEC TABLET7DAYSX3 28TABLET1688484100.00000Replenished 1001899045 3063437222