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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 000000780454 MR002395530003/10/202103/10/202103/11/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET848484100.00000Replenished 1001824882 3049647435
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780720 MR003913090003/23/202103/23/202103/25/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET84842833.33300Replenished 1001854421 3055134799
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780720 MR003913090003/23/202103/23/202103/25/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET84845666.66700Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783800 MR003477980008/04/202108/04/202108/05/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001899595 3063713218
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784698 MR002651350009/10/202109/10/202109/11/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001926498 3068455122
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785292 MR003927550010/05/202110/05/202110/06/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001952043 3072719019
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785972 MR003927550011/02/202111/02/202111/03/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001952043 3072719019
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786344 MR003477980011/18/202111/18/202111/19/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001966593 3075785867
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786670 MR002395530012/03/202112/03/202112/04/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET84842833.33300Replenished 1001966593 3075785867
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786670 MR002395530012/03/202112/03/202112/04/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET84845666.66700Replenished 1001974643 3077188620