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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 000000782989 MR001923510006/30/202106/30/202107/01/202168001047000METOPROLOL SUCC ER 100 MG TAB100 MGTAB.SR 24H100901011.11100Replenished 1001883742 3060343039
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782989 MR001923510006/30/202106/30/202107/01/202168001047000METOPROLOL SUCC ER 100 MG TAB100 MGTAB.SR 24H100908088.88900Replenished 1001897770 3062993331
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783639 MR000876280007/28/202107/28/202107/29/202168001047000METOPROLOL SUCC ER 100 MG TAB100 MGTAB.SR 24H100902022.22200Replenished 1001897770 3062993331
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783639 MR000876280007/28/202107/28/202107/29/202168001047000METOPROLOL SUCC ER 100 MG TAB100 MGTAB.SR 24H100907077.77800Replenished 1001899595 3063713218
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783802 MR001542460008/04/202108/04/202108/05/202168001047000METOPROLOL SUCC ER 100 MG TAB100 MGTAB.SR 24H100603050.00000Replenished 1001899595 3063713218
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783802 MR001542460008/04/202108/04/202108/05/202168001047000METOPROLOL SUCC ER 100 MG TAB100 MGTAB.SR 24H100603050.00000Replenished 1001905867 3064981467
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784300 MR001128430008/25/202108/25/202108/26/202168001047000METOPROLOL SUCC ER 100 MG TAB100 MGTAB.SR 24H100901011.11100Replenished 1001925175 3068316933
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784300 MR001128430008/25/202108/25/202108/26/202168001047000METOPROLOL SUCC ER 100 MG TAB100 MGTAB.SR 24H100908088.88900Replenished 1001917157 3066422605
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784575 MR001542460009/07/202109/07/202109/08/202168001047000METOPROLOL SUCC ER 100 MG TAB100 MGTAB.SR 24H1006060100.00000Replenished 1001925175 3068316933
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784908 MR000255130009/20/202109/20/202109/21/202168001047000METOPROLOL SUCC ER 100 MG TAB100 MGTAB.SR 24H100903033.33300Replenished 1001925175 3068316933