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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 000000779073 MR003913090001/08/202101/08/202101/09/202168001000501METHYLPREDNISOLONE 4 MG DOSEPK4 MGTAB DS PK2121628.57100Replenished 1001811909 987581092
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779073 MR003913090001/08/202101/08/202101/09/202168001000501METHYLPREDNISOLONE 4 MG DOSEPK4 MGTAB DS PK21211571.42900Replenished 1001793792
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779802 MR001174460002/10/202102/10/202102/11/202168001000501METHYLPREDNISOLONE 4 MG DOSEPK4 MGTAB DS PK212121100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779923 B6VYVWDV5DVD0002/16/202102/16/202102/17/202168001000501METHYLPREDNISOLONE 4 MG DOSEPK4 MGTAB DS PK2121628.57100Replenished 1001817241 988063131
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779923 B6VYVWDV5DVD0002/16/202102/16/202102/17/202168001000501METHYLPREDNISOLONE 4 MG DOSEPK4 MGTAB DS PK21211571.42900Replenished 1001811909 987581092
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780171 MR000929910002/25/202102/25/202102/26/202168001000501METHYLPREDNISOLONE 4 MG DOSEPK4 MGTAB DS PK2121628.57100Replenished 1001826768 3050065356
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780171 MR000929910002/25/202102/25/202102/26/202168001000501METHYLPREDNISOLONE 4 MG DOSEPK4 MGTAB DS PK21211571.42900Replenished 1001817241 988063131
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780537 MR001082060003/15/202103/15/202103/16/202168001000501METHYLPREDNISOLONE 4 MG DOSEPK4 MGTAB DS PK2121628.57100Replenished 1001828853 3050481048
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780537 MR001082060003/15/202103/15/202103/16/202168001000501METHYLPREDNISOLONE 4 MG DOSEPK4 MGTAB DS PK21211571.42900Replenished 1001826768 3050065356
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780632 MR001622560003/18/202103/18/202103/19/202168001000501METHYLPREDNISOLONE 4 MG DOSEPK4 MGTAB DS PK2121628.57100Replenished 1001830087 3050733659