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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 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 000000781751 MR002937890005/06/202105/06/202105/07/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1001854421 3055134799
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781617 MR002798370005/03/202105/03/202105/04/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1001854421 3055134799
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782409 MR002395530006/04/202106/04/202106/05/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1001882607 3060033992
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 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 000000784401 MR002028490008/30/202108/30/202108/31/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1001937905 3070173196
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