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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 000000799564 MR003614600008/07/202308/07/202308/08/202368462013281NORETHIND-ETH ESTRAD 1-0.02 MG1MG-20MCGTABLET636363100.00000Replenished08/10/2023 1002254151 3142973963
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000798891 MR003614600006/29/202306/29/202306/30/202368462013281NORETHIND-ETH ESTRAD 1-0.02 MG1MG-20MCGTABLET636363100.00000Replenished07/03/2023 1002239218 3138618791
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795279 MR003614600305/03/202305/03/202305/04/202368462013281NORETHIND-ETH ESTRAD 1-0.02 MG1MG-20MCGTABLET636363100.00000Replenished05/08/2023 1002213418 3132524753
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795279 MR003614600203/23/202303/23/202303/24/202368462013281NORETHIND-ETH ESTRAD 1-0.02 MG1MG-20MCGTABLET636363100.00000Replenished 1002195085 3127879945
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795279 MR003614600102/15/202302/15/202302/16/202368462013281NORETHIND-ETH ESTRAD 1-0.02 MG1MG-20MCGTABLET636363100.00000Replenished 1002179310 3123694460
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795279 MR003614600001/05/202301/05/202301/06/202368462013281NORETHIND-ETH ESTRAD 1-0.02 MG1MG-20MCGTABLET636363100.00000Replenished 1002160851 3118886767
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791659 MR003614600210/26/202210/26/202210/27/202268462013281NORETHIND-ETH ESTRAD 1-0.02 MG1MG-20MCGTABLET636363100.00000Replenished 1002126238 3110721551
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791659 MR003614600007/21/202207/21/202207/22/202268462013281NORETHIND-ETH ESTRAD 1-0.02 MG1MG-20MCGTABLET636363100.00000Replenished 1002082636 3100356570
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790505 MR003614600005/25/202205/26/202205/27/202268462013281NORETHIND-ETH ESTRAD 1-0.02 MG1MG-20MCGTABLET636363100.00000Replenished 1002058743 3094409887