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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 000000795359 MR003582440001/09/202301/09/202301/10/202355111014430FLUCONAZOLE 100 MG TABLET100 MGTABLET301414100.00000Replenished04/17/2023 1002207066 3130202878
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000796180 MR003582440002/17/202302/17/202302/18/202355111014430FLUCONAZOLE 100 MG TABLET100 MGTABLET3077100.00000Replenished04/17/2023 1002207066 3130202878
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797251 MR003582440004/11/202304/11/202304/13/202355111014430FLUCONAZOLE 100 MG TABLET100 MGTABLET3014964.28600Replenished04/17/2023 1002207066 3130202878
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787362 MR002187830001/03/202201/03/202201/05/202255111014430FLUCONAZOLE 100 MG TABLET100 MGTABLET307342.85700Replenished 1001984636 3079137424
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784075 MR001646910008/16/202108/16/202108/17/202155111014430FLUCONAZOLE 100 MG TABLET100 MGTABLET302020100.00000Replenished 1001984636 3079137424
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786526 MR000050780011/29/202111/29/202111/30/202155111014430FLUCONAZOLE 100 MG TABLET100 MGTABLET3077100.00000Replenished 1001984636 3079137424