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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 000000793628 MR002630840010/18/202210/18/202210/19/202270700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84845666.66700Replenished 1002076632 3098638591
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791354 MR002630840007/06/202207/06/202207/07/202270700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84842833.33300Replenished 1002076632 3098638591
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791354 MR002630840007/06/202207/06/202207/07/202270700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84845666.66700Replenished 1002077322 3098828684
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788236 MR002630840002/11/202202/11/202202/12/202270700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84842833.33300Replenished 1002077322 3098828684
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788236 MR002630840002/11/202202/11/202202/12/202270700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84845666.66700Replenished 1002004973 3083258060
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784202 BLUC9JFJ7EEY0112/20/202112/20/202112/21/202170700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84842833.33300Replenished 1002004973 3083258060
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784202 BLUC9JFJ7EEY0112/20/202112/20/202112/21/202170700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84845666.66700Replenished 1001976721 3077692823
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786829 MR002630840012/13/202112/13/202112/14/202170700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84562850.00000Replenished 1001973568 3076863124
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786829 MR002630840012/13/202112/13/202112/14/202170700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84562850.00000Replenished 1001976721 3077692823
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786672 MR003913090012/03/202112/03/202112/04/202170700011385ISIBLOOM 28 DAY TABLET0.15-0.03TABLET84842833.33300Replenished 1001966593 3075785867