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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 000000776630 MR002290390201/15/202101/15/202101/16/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100902022.22200Replenished 1001814475 987756775
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776630 MR002290390201/15/202101/15/202101/16/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100907077.77800Replenished 1001797497
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776603 MR000557370401/19/202101/19/202101/20/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET1006060100.00000Replenished 1001814475 987756775
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776603 MR000557370502/18/202102/18/202102/19/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100602033.33300Replenished 1001814475 987756775
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776603 MR000557370502/18/202102/18/202102/19/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100604066.66700Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780234 MR002341130003/01/202103/01/202103/02/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET100270103.70400Replenished 1001835626 3051655272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780234 MR002341130003/01/202103/01/202103/02/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET1002706022.22200Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780234 MR002341130003/01/202103/01/202103/02/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET10027010037.03700Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780234 MR002341130003/01/202103/01/202103/02/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET10027010037.03700Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780620 MR000557370003/18/202103/18/202103/19/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET1006060100.00000Replenished 1001835626 3051655272