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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 000000776873 MR002257040308/13/202108/13/202108/14/202165862056090PANTOPRAZOLE SOD DR 40 MG TAB40 MGTABLET DR909090100.00000Replenished 1001903802 3064589183
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779966 MR002486460108/06/202108/06/202108/07/202165862056090PANTOPRAZOLE SOD DR 40 MG TAB40 MGTABLET DR909090100.00000Replenished 1001900472 3063887831
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779966 MR002486460211/05/202111/05/202111/06/202165862056090PANTOPRAZOLE SOD DR 40 MG TAB40 MGTABLET DR90903437.77800Replenished 1001953128 3073037530
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779966 MR002486460211/05/202111/05/202111/06/202165862056090PANTOPRAZOLE SOD DR 40 MG TAB40 MGTABLET DR90905662.22200Replenished 1001956102 3073301294
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779966 MR002486460302/01/202202/01/202202/02/202265862056090PANTOPRAZOLE SOD DR 40 MG TAB40 MGTABLET DR90903538.88900Replenished 1002001191 3082500309
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779966 MR002486460302/01/202202/01/202202/02/202265862056090PANTOPRAZOLE SOD DR 40 MG TAB40 MGTABLET DR90905561.11100Replenished 1001998721 3082187336
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780779 MR000324410108/09/202108/09/202108/10/202165862056090PANTOPRAZOLE SOD DR 40 MG TAB40 MGTABLET DR901809050.00000Replenished 1001902393 3064140711
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780779 MR000324410108/09/202108/09/202108/10/202165862056090PANTOPRAZOLE SOD DR 40 MG TAB40 MGTABLET DR901809050.00000Replenished 1001902393 3064140711
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780779 MR000324410211/08/202111/08/202111/09/202165862056090PANTOPRAZOLE SOD DR 40 MG TAB40 MGTABLET DR901802614.44400Replenished 1001958724 3073746995
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780779 MR000324410211/08/202111/08/202111/09/202165862056090PANTOPRAZOLE SOD DR 40 MG TAB40 MGTABLET DR901803016.66700Replenished 1001956102 3073301294