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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 000000773682 MR002486460403/01/202103/01/202103/02/202165162076610WARFARIN SODIUM 5 MG TABLET5 MGTABLET1003004013.33300Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000773682 MR002486460403/01/202103/01/202103/02/202165162076610WARFARIN SODIUM 5 MG TABLET5 MGTABLET1003007324.33300Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000773682 MR002486460403/01/202103/01/202103/02/202165162076610WARFARIN SODIUM 5 MG TABLET5 MGTABLET1003008729.00100Replenished 1001829373 3050481049
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000773682 MR002486460403/01/202103/01/202103/02/202165162076610WARFARIN SODIUM 5 MG TABLET5 MGTABLET10030010033.33300Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779471 MR000186700001/26/202101/26/202101/27/202165162076610WARFARIN SODIUM 5 MG TABLET5 MGTABLET10060711.66700Replenished 1001817241 988063131
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779471 MR000186700001/26/202101/26/202101/27/202165162076610WARFARIN SODIUM 5 MG TABLET5 MGTABLET100605388.33300Replenished 1001802067
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779600 MR001715220002/01/202102/01/202102/02/202165162076610WARFARIN SODIUM 5 MG TABLET5 MGTABLET1006060100.00000Replenished 1001817241 988063131
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780188 MR000186700002/25/202102/25/202102/26/202165162076610WARFARIN SODIUM 5 MG TABLET5 MGTABLET100602745.00000Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780188 MR000186700002/25/202102/25/202102/26/202165162076610WARFARIN SODIUM 5 MG TABLET5 MGTABLET100603355.00000Replenished 1001817241 988063131
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780262 MR001715220003/01/202103/01/202103/02/202165162076610WARFARIN SODIUM 5 MG TABLET5 MGTABLET1006060100.00000Replenished 1001819373 988099025