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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 000000796440 MR003482610003/02/202303/02/202303/03/202368001040407LEVETIRACETAM 750 MG TABLET750 MGTABLET120120120100.00000Replenished 1002184466 3125496601
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000796440 MR003482610104/04/202304/04/202304/05/202368001040407LEVETIRACETAM 750 MG TABLET750 MGTABLET120120120100.00000Replenished 1002199093 3129254774
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000796440 MR003482610205/02/202305/02/202305/04/202368001040407LEVETIRACETAM 750 MG TABLET750 MGTABLET120120120100.00000Replenished05/08/2023 1002213418 3132524753
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000796440 MR003482610308/11/202308/11/202308/12/202368001040407LEVETIRACETAM 750 MG TABLET750 MGTABLET1201206050.00000Replenished08/14/2023 1002258322 3143269123
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797107 MR003966920308/07/202308/07/202308/08/202368001040407LEVETIRACETAM 750 MG TABLET750 MGTABLET1206060100.00000Replenished08/14/2023 1002258322 3143269123