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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 000000789174 MR001957350003/24/202203/24/202203/25/202268001039700FAMOTIDINE 20 MG TABLET20 MGTABLET1008444.76200Replenished 1002039367 3090544681
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791385 MR001174460007/07/202207/07/202207/08/202268001039700FAMOTIDINE 20 MG TABLET20 MGTABLET1006046.66700Replenished 1002087130 3101872451
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792702 MR002897470009/06/202209/06/202209/09/202268001039700FAMOTIDINE 20 MG TABLET20 MGTABLET10030413.33300Replenished 1002114625 3108158138
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792702 MR002897470211/17/202211/17/202211/18/202268001039700FAMOTIDINE 20 MG TABLET20 MGTABLET10030413.33300Replenished 1002150356 3116568459
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795265 MR002484860001/04/202301/04/202301/05/202368001039700FAMOTIDINE 20 MG TABLET20 MGTABLET1006046.66700Replenished 1002178681 3123384823
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787630 MR000303240304/19/202204/19/202204/20/202268001039700FAMOTIDINE 20 MG TABLET20 MGTABLET10030620.00000Replenished 1002039367 3090544681
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791828 MR000272440112/27/202212/27/202212/28/202268001039700FAMOTIDINE 20 MG TABLET20 MGTABLET10060610.00000Replenished 1002154521 3117768446
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791990 MR000353890008/04/202208/04/202208/05/202268001039700FAMOTIDINE 20 MG TABLET20 MGTABLET10060610.00000Replenished 1002087130 3101872451
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792702 MR002897470302/13/202302/13/202302/14/202368001039700FAMOTIDINE 20 MG TABLET20 MGTABLET10030620.00000Replenished 1002178681 3123384823
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785124 MR002897470211/22/202111/22/202111/23/202168001039700FAMOTIDINE 20 MG TABLET20 MGTABLET100301033.33300Replenished 1001986240 3079460588