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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 000000779875 18820002/12/202102/12/202102/13/202165862050220AMOX-CLAV 500-125 MG TABLET500-125 MGTABLET20242083.33300Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784360 MR002484860008/27/202108/27/202108/28/202165862050220AMOX-CLAV 500-125 MG TABLET500-125 MGTABLET201414100.00000Replenished 1001990453 3080516021
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787685 MR001786960001/17/202201/17/202201/18/202265862050220AMOX-CLAV 500-125 MG TABLET500-125 MGTABLET2014642.85700Replenished 1001990453 3080516021
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787685 MR001786960001/17/202201/17/202201/18/202265862050220AMOX-CLAV 500-125 MG TABLET500-125 MGTABLET2014857.14300Replenished 1002020474 3086983191
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789004 MR001174460003/17/202203/17/202203/18/202265862050220AMOX-CLAV 500-125 MG TABLET500-125 MGTABLET2014214.28600Replenished 1002037486 3090307729
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789004 MR001174460003/17/202203/17/202203/18/202265862050220AMOX-CLAV 500-125 MG TABLET500-125 MGTABLET20141285.71400Replenished 1002020474 3086983191
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789629 MR003038270004/18/202204/18/202204/19/202265862050220AMOX-CLAV 500-125 MG TABLET500-125 MGTABLET2020210.00000Replenished 1002118447 3108304458
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789629 MR003038270004/18/202204/18/202204/19/202265862050220AMOX-CLAV 500-125 MG TABLET500-125 MGTABLET20201890.00000Replenished 1002037486 3090307729
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793301 MR000729920010/04/202210/04/202210/05/202265862050220AMOX-CLAV 500-125 MG TABLET500-125 MGTABLET2021314.28600Replenished 1002149821 3116206380
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793301 MR000729920010/04/202210/04/202210/05/202265862050220AMOX-CLAV 500-125 MG TABLET500-125 MGTABLET20211885.71400Replenished 1002118447 3108304458