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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 000000775261 MR003248850202/08/202102/08/202102/09/202168001015200CARVEDILOL 25 MG TABLET25 MGTABLET1001802011.11100Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775261 MR003248850202/08/202102/08/202102/09/202168001015200CARVEDILOL 25 MG TABLET25 MGTABLET1001806033.33300Replenished 1001816056 987916714
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775261 MR003248850202/08/202102/08/202102/09/202168001015200CARVEDILOL 25 MG TABLET25 MGTABLET10018010055.55600Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775261 MR003248850305/10/202105/10/202105/11/202168001015200CARVEDILOL 25 MG TABLET25 MGTABLET1001802011.11100Replenished 1001856282 3055381317
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775261 MR003248850305/10/202105/10/202105/11/202168001015200CARVEDILOL 25 MG TABLET25 MGTABLET1001806033.33300Replenished 1001866451 3057164798
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775261 MR003248850305/10/202105/10/202105/11/202168001015200CARVEDILOL 25 MG TABLET25 MGTABLET10018010055.55600Replenished 1001856282 3055381317
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778171 MR000977320201/28/202101/28/202101/29/202168001015200CARVEDILOL 25 MG TABLET25 MGTABLET1001204033.33300Replenished 1001803460
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778171 MR000977320201/28/202101/28/202101/29/202168001015200CARVEDILOL 25 MG TABLET25 MGTABLET1001208066.66700Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778171 MR000977320303/02/202103/02/202103/03/202168001015200CARVEDILOL 25 MG TABLET25 MGTABLET1001206050.00000Replenished 1001819785 3048855808
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778171 MR000977320303/02/202103/02/202103/03/202168001015200CARVEDILOL 25 MG TABLET25 MGTABLET1001206050.00000Replenished 1001824882 3049647435