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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 000000780415 MR002484860003/09/202103/09/202103/10/202100527329046LEVOTHYROXINE 200 MCG TABLET200 MCGTABLET903030100.00000Replenished 1001825961 3049810904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780519 MR000182390003/12/202103/12/202103/13/202100527329046LEVOTHYROXINE 200 MCG TABLET200 MCGTABLET90906066.66700Replenished 1001825961 3049810904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780519 MR000182390003/12/202103/12/202103/13/202100527329046LEVOTHYROXINE 200 MCG TABLET200 MCGTABLET90903033.33300Replenished 1001877828 3059333148
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782771 MR000182390006/21/202106/21/202106/22/202100527329046LEVOTHYROXINE 200 MCG TABLET200 MCGTABLET90906066.66700Replenished 1001877828 3059333148
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782771 MR000182390006/21/202106/21/202106/22/202100527329046LEVOTHYROXINE 200 MCG TABLET200 MCGTABLET90903033.33300Replenished 1001903802 3064589183
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783397 MR003890110007/16/202107/16/202107/17/202100527329046LEVOTHYROXINE 200 MCG TABLET200 MCGTABLET903030100.00000Replenished 1001903802 3064589183
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783397 MR003890110108/13/202108/13/202108/14/202100527329046LEVOTHYROXINE 200 MCG TABLET200 MCGTABLET903030100.00000Replenished 1001903802 3064589183
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784693 MR003890110009/10/202109/10/202109/11/202100527329046LEVOTHYROXINE 200 MCG TABLET200 MCGTABLET903030100.00000Replenished 1001928804 3069023028
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785069 MR000182390009/27/202109/27/202109/28/202100527329046LEVOTHYROXINE 200 MCG TABLET200 MCGTABLET90906066.66700Replenished 1001928804 3069023028
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784693 MR003890110110/14/202110/14/202110/15/202100527329046LEVOTHYROXINE 200 MCG TABLET200 MCGTABLET903030100.00000Replenished 1001959026 3073746996