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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 000000774768 MR001709230204/05/202104/05/202104/07/202129300011201LAMOTRIGINE 100 MG TABLET100 MGTABLET1001808044.44400Replenished 1001903497 3064589180
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774768 MR001709230204/05/202104/05/202104/07/202129300011201LAMOTRIGINE 100 MG TABLET100 MGTABLET10018010055.55600Replenished 1001838628 3052278967
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784004 MR001709230008/12/202108/12/202108/13/202129300011201LAMOTRIGINE 100 MG TABLET100 MGTABLET1001802011.11100Replenished 1001903497 3064589180
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784004 MR001709230008/12/202108/12/202108/13/202129300011201LAMOTRIGINE 100 MG TABLET100 MGTABLET1001806033.33300Replenished 1001965091 3075301281
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784004 MR001709230008/12/202108/12/202108/13/202129300011201LAMOTRIGINE 100 MG TABLET100 MGTABLET10018010055.55600Replenished 1001903497 3064589180
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784004 MR001709230111/29/202111/29/202111/30/202129300011201LAMOTRIGINE 100 MG TABLET100 MGTABLET1001804022.22200Replenished 1001965091 3075301281
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784004 MR001709230111/29/202111/29/202111/30/202129300011201LAMOTRIGINE 100 MG TABLET100 MGTABLET1001804022.22200Replenished 1002017255 3085917756
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784004 MR001709230111/29/202111/29/202111/30/202129300011201LAMOTRIGINE 100 MG TABLET100 MGTABLET10018010055.55600Replenished 1001965091 3075301281
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784004 MR001709230203/07/202203/07/202203/08/202229300011201LAMOTRIGINE 100 MG TABLET100 MGTABLET1001802011.11100Replenished 1002081368 3099576880
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784004 MR001709230203/07/202203/07/202203/08/202229300011201LAMOTRIGINE 100 MG TABLET100 MGTABLET1001806033.33300Replenished 1002017255 3085917756