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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 000004011639 MR002028490009/07/202109/07/202109/08/202116729013700CLONAZEPAM 1 MG TABLET1 MGTABLET1006023.33400Replenished 1001926498 3068455121
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011819 MR002109290010/21/202110/21/202110/22/202116729013700CLONAZEPAM 1 MG TABLET1 MGTABLET1009022.22200Replenished 1001946740 3071601881
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011666 MR002109290008/10/202108/10/202108/11/202116729013700CLONAZEPAM 1 MG TABLET1 MGTABLET1009044.44400Replenished 1001902816 3064329314
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011887 MR001778440011/29/202111/29/202111/30/202116729013700CLONAZEPAM 1 MG TABLET1 MGTABLET1005647.14300Replenished 1001981624 3078485430
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011963 MR002028490001/07/202201/07/202201/08/202216729013700CLONAZEPAM 1 MG TABLET1 MGTABLET1006046.66700Replenished 1002003398 3082924517
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012148 MR002109290004/28/202204/28/202204/29/202216729013700CLONAZEPAM 1 MG TABLET1 MGTABLET1009044.44400Replenished 1002050106 3092568971
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012064 MR001527150207/15/202207/15/202207/16/202216729013700CLONAZEPAM 1 MG TABLET1 MGTABLET1009066.66700Replenished 1002081368 3099576539
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012304 MR002028490210/10/202210/10/202210/11/202216729013700CLONAZEPAM 1 MG TABLET1 MGTABLET10060610.00000Replenished 1002120077 3108911369
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012440 MR002109290011/18/202211/18/202211/19/202216729013700CLONAZEPAM 1 MG TABLET1 MGTABLET1009066.66700Replenished 1002137939 3113250052
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011752 MR002109290009/21/202109/21/202109/22/202116729013700CLONAZEPAM 1 MG TABLET1 MGTABLET1009088.88900Replenished 1001926498 3068455121