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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 000000777391 MR000395960010/26/202010/26/202010/27/202068001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1001816393 987952822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778614 MR002028490012/16/202012/16/202012/18/202068001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1001816393 987952822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779984 MR000255130002/18/202102/18/202102/19/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1001816393 987952822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780016 MR003284060002/19/202102/19/202102/20/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1233100.00000Replenished 1001816393 987952822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780101 MR002160690002/23/202102/23/202102/24/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1001816393 987952822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780110 MR001982700002/23/202102/23/202102/24/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET122150.00000Replenished 1001816393 987952822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780110 MR001982700002/23/202102/23/202102/24/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET122150.00000Replenished 1001850290 3054303929
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780353 MR001697170003/05/202103/05/202103/06/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1001850290 3054303929
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780730 MR000378510003/23/202103/23/202103/25/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1001850290 3054303929
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780940 MR001011130004/01/202104/01/202104/02/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1244100.00000Replenished 1001850290 3054303929