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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 000000788172 MR000820700002/07/202202/07/202202/08/202268001025317FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1002012950 3084815368
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788426 MR002505580002/21/202202/21/202202/22/202268001025317FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1002012950 3084815368
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788559 MR002521900002/25/202202/25/202202/26/202268001025317FLUCONAZOLE 150 MG TABLET150 MGTABLET1220840.00000Replenished 1002012950 3084815368
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788559 MR002521900002/25/202202/25/202202/26/202268001025317FLUCONAZOLE 150 MG TABLET150 MGTABLET12201260.00000Replenished 1002012950 3084815368
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788582 BA76RRTH2GDY0002/25/202202/28/202203/01/202268001025317FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1002070629 3097050648
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788820 MR001646910003/09/202203/09/202203/10/202268001025317FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1002070629 3097050648
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789048 MR000876280003/21/202203/21/202203/22/202268001025317FLUCONAZOLE 150 MG TABLET150 MGTABLET1244100.00000Replenished 1002070629 3097050648
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789652 MR001955040004/19/202204/19/202204/20/202268001025317FLUCONAZOLE 150 MG TABLET150 MGTABLET1233100.00000Replenished 1002070629 3097050648
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791010 MR002334060006/20/202206/20/202206/21/202268001025317FLUCONAZOLE 150 MG TABLET150 MGTABLET122150.00000Replenished 1002070629 3097050648
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791010 MR002334060006/20/202206/20/202206/21/202268001025317FLUCONAZOLE 150 MG TABLET150 MGTABLET122150.00000Replenished 1002168256 3121399107