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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 000000784336 MR002965900008/26/202108/26/202108/27/202145802006436TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)808080100.00000Replenished 1001911378 3066004376
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785029 MR001116100009/23/202109/23/202109/24/202145802006436TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)808080100.00000Replenished 1001927749 3068767552
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785164 MR000503020009/29/202109/29/202109/30/202145802006436TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)808080100.00000Replenished 1001929791 3069291945
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785604 MR000471640010/18/202110/18/202110/19/202145802006436TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)808080100.00000Replenished 1001945251 3071148263
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792898 MR001513540009/14/202209/15/202209/16/202245802006436TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)808080100.00000Replenished 1002108257 3106376963
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000796671 MR001513540003/13/202303/13/202303/14/202345802006436TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)808080100.00000Replenished 1002188313 3126619593
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000798681 MR000503020006/20/202306/20/202306/21/202345802006436TRIAMCINOLONE 0.1% CREAM0.1 %CREAM(GM)808080100.00000Replenished06/22/2023 1002235956 3137532515