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 000000789559 MR003195940004/14/202204/14/202204/15/202265702071110ACCU-CHEK GUIDE TEST STRIPSTRIP505050100.00000Replenished 1002036295 3089902768
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790242 MR003195940005/16/202205/16/202205/17/202265702071110ACCU-CHEK GUIDE TEST STRIPSTRIP505050100.00000Replenished 1002052652 3093325137
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790242 MR003195940107/08/202207/08/202207/09/202265702071110ACCU-CHEK GUIDE TEST STRIPSTRIP505050100.00000Replenished 1002077877 3098828685
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790242 MR003195940209/06/202209/06/202209/09/202265702071110ACCU-CHEK GUIDE TEST STRIPSTRIP505050100.00000Replenished 1002102296 3105614641
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790242 MR003195940310/27/202210/27/202210/28/202265702071110ACCU-CHEK GUIDE TEST STRIPSTRIP505050100.00000Replenished 1002126984 3110896802
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790242 MR003195940412/13/202212/13/202212/15/202265702071110ACCU-CHEK GUIDE TEST STRIPSTRIP505050100.00000Replenished 1002150356 3116568457
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795335 MR003195940001/09/202301/09/202301/10/202365702071110ACCU-CHEK GUIDE TEST STRIPSTRIP505050100.00000Replenished 1002161832 3119403852
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795335 MR003195940103/20/202303/20/202303/21/202365702071110ACCU-CHEK GUIDE TEST STRIPSTRIP505050100.00000Replenished 1002193992 3127402541
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795335 MR003195940205/17/202305/17/202305/18/202365702071110ACCU-CHEK GUIDE TEST STRIPSTRIP505050100.00000Replenished05/19/2023 1002221549 3133876130
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000796812 MR001715220003/21/202303/21/202303/22/202365702071110ACCU-CHEK GUIDE TEST STRIPSTRIP501005050.00000Replenished 1002194250 3127552215