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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 000000772286 MR002561370201/15/202101/15/202101/16/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET1009055.55600Replenished 1001835626 3051655272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000772286 MR002561370201/15/202101/15/202101/16/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET100908594.44400Replenished 1001797497
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777474 MR001741360101/22/202101/22/202101/23/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET100903538.88900Replenished 1001835626 3051655272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777474 MR001741360101/22/202101/22/202101/23/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET100905561.11100Replenished 1001830991 3050869519
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777814 MR000305490302/11/202102/11/202102/12/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET1003030100.00000Replenished 1001830991 3050869519
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779871 MR002980170002/12/202102/12/202102/13/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET1001515100.00000Replenished 1001830991 3050869519
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780507 MR000305490003/12/202103/12/202103/13/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET1003030100.00000Replenished 1001835626 3051655272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779871 MR002980170103/15/202103/15/202103/16/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET1001515100.00000Replenished 1001835626 3051655272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780907 MR001901990003/31/202103/31/202104/01/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET100901516.66700Replenished 1001835626 3051655272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780907 MR001901990003/31/202103/31/202104/01/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET100907583.33300Replenished 1001839679 3052473904