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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 000000774657 MR000220060306/17/202106/17/202106/18/202165162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE1001802011.11100Replenished 1001876050 3059092759
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774657 MR000220060306/17/202106/17/202106/18/202165162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE1001806033.33300Replenished 1001877828 3059333148
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774657 MR000220060306/17/202106/17/202106/18/202165162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE10018010055.55600Replenished 1001876050 3059092759
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776042 MR001198520403/24/202103/24/202103/25/202165162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE100120108.33300Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776042 MR001198520403/24/202103/24/202103/25/202165162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE1001203025.00000Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776042 MR001198520403/24/202103/24/202103/25/202165162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE1001208066.66700Replenished 1001834470 3051403572
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777794 MR001646910202/12/202102/12/202102/13/202165162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE1009090100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778477 MR000309190202/09/202102/09/202102/10/202165162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE100901011.11100Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778477 MR000309190202/09/202102/09/202102/10/202165162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE100901011.11100Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778477 MR000309190202/09/202102/09/202102/10/202165162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE100907077.77800Replenished 1001811232 987509358