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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 000000792494 MR000820700008/26/202208/26/202208/27/202268001036500METRONIDAZOLE 500 MG TABLET500 MGTABLET100141392.85700Replenished 1002098027 3104187397
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791996 MR003344950008/05/202208/05/202208/06/202268001036500METRONIDAZOLE 500 MG TABLET500 MGTABLET1002020100.00000Replenished 1002098027 3104187397
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791047 MR002334060006/22/202206/22/202206/23/202268001036500METRONIDAZOLE 500 MG TABLET500 MGTABLET1001414100.00000Replenished 1002098027 3104187397
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790765 MR002086360006/08/202206/08/202206/09/202268001036500METRONIDAZOLE 500 MG TABLET500 MGTABLET1004242100.00000Replenished 1002098027 3104187397
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788469 MR001011130002/22/202202/22/202202/23/202268001036500METRONIDAZOLE 500 MG TABLET500 MGTABLET100281139.28600Replenished 1002098027 3104187397
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788469 MR001011130002/22/202202/22/202202/23/202268001036500METRONIDAZOLE 500 MG TABLET500 MGTABLET100281760.71400Replenished 1002010073 3084421079
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786604 MR001852200011/30/202111/30/202112/01/202168001036500METRONIDAZOLE 500 MG TABLET500 MGTABLET1004242100.00000Replenished 1002010073 3084421079
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786281 MR003344950011/17/202111/17/202111/18/202168001036500METRONIDAZOLE 500 MG TABLET500 MGTABLET1001414100.00000Replenished 1002010073 3084421079
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784205 MR001852200008/19/202108/19/202108/20/202168001036500METRONIDAZOLE 500 MG TABLET500 MGTABLET1002121100.00000Replenished 1002010073 3084421079
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782748 MR002395530006/18/202106/18/202106/19/202168001036500METRONIDAZOLE 500 MG TABLET500 MGTABLET10014642.85700Replenished 1002010073 3084421079