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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 000000787800 MR001520150211/17/202211/17/202211/18/202216729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET100903033.33300Replenished 1002137601 3113250051
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792688 MR001613010211/02/202211/02/202211/05/202216729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET1003030100.00000Replenished 1002137601 3113250051
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792688 MR001613010110/04/202210/04/202210/05/202216729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET1003030100.00000Replenished 1002137601 3113250051
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786826 MR002897470309/15/202209/15/202209/16/202216729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET100901011.11100Replenished 1002137601 3113250051
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786826 MR002897470309/15/202209/15/202209/16/202216729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET100908088.88900Replenished 1002108257 3106376963
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792688 MR001613010009/06/202209/06/202209/09/202216729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET100301033.33300Replenished 1002102296 3105614642
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792688 MR001613010009/06/202209/06/202209/09/202216729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET100302066.66700Replenished 1002108257 3106376963
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790104 MR001613010308/04/202208/04/202208/05/202216729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET1003030100.00000Replenished 1002102296 3105614642
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787800 MR001520150107/25/202207/25/202207/26/202216729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET100903033.33300Replenished 1002083390 3100621822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787800 MR001520150107/25/202207/25/202207/26/202216729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET100906066.66700Replenished 1002102296 3105614642