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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 000000775957 MR003195940211/14/202011/14/202011/15/202068001036000METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H100301033.33300Replenished 1001816393 987952822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775957 MR003195940211/14/202011/14/202011/15/202068001036000METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H100302066.66700Replenished 1001765042
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778634 MR003195940012/17/202012/17/202012/18/202068001036000METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1001816393 987952822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779348 MR003195940001/20/202101/20/202101/21/202168001036000METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1001816393 987952822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779348 MR003195940102/23/202102/23/202102/24/202168001036000METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1001816393 987952822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779348 MR003195940203/24/202103/24/202103/25/202168001036000METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1001851763 3054766187
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780836 MR001797270003/29/202103/29/202103/30/202168001036000METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1001851763 3054766187
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779348 MR003195940304/26/202104/26/202104/27/202168001036000METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1001851763 3054766187
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781642 MR001797270005/03/202105/03/202105/04/202168001036000METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H100301033.33300Replenished 1001851763 3054766187