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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 000000787309 MR002793581111/26/202211/26/202211/27/202268001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H1003030100.00000Replenished 1002151208 3116741985
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787459 MR001655311112/06/202212/06/202212/07/202268001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H100301033.33300Replenished 1002151208 3116741985
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794001 MR003951960011/21/202211/21/202211/22/202268001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H1003030100.00000Replenished 1002151208 3116741985
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794328 MR000272440011/18/202211/18/202211/19/202268001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H1003030100.00000Replenished 1002151208 3116741985
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787363 MR000952170311/03/202211/03/202211/05/202268001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H100902022.22200Replenished 1002136666 3112767814
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790097 MR002937890211/14/202211/14/202211/15/202268001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H100902022.22200Replenished 1002136666 3112767814
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790097 MR002937890211/14/202211/14/202211/15/202268001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H100907077.77800Replenished 1002136666 3112767814
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792408 MR003891180111/09/202211/09/202211/10/202268001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H1006060100.00000Replenished 1002136666 3112767814
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794212 MR001285720011/14/202211/14/202211/15/202268001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H1003030100.00000Replenished 1002136666 3112767814
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787363 MR000952170311/03/202211/03/202211/05/202268001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H100907077.77800Replenished 1002129142 3111671677