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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 000000774134 MR000374450702/17/202102/17/202102/18/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET903030100.00000Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774134 MR000374450803/29/202103/29/202103/30/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET90301550.00000Replenished 1001834470 3051403572
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774134 MR000374450803/29/202103/29/202103/30/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET90301550.00000Replenished 1001842172 3052723058
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781743 MR000374450005/06/202105/06/202105/07/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET9030310.00000Replenished 1001854421 3055134799
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781743 MR000374450005/06/202105/06/202105/07/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET90302790.00000Replenished 1001856282 3055381317
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782491 MR000374450006/08/202106/08/202106/09/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET903030100.00000Replenished 1001872170 3058237732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782491 MR000374450107/14/202107/14/202107/15/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET903030100.00000Replenished 1001889916 3061619489
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782491 MR000374450208/20/202108/20/202108/21/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET90301240.00000Replenished 1001921962 3067326644
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782491 MR000374450208/20/202108/20/202108/21/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET90301860.00000Replenished 1001906780 3065449437
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782491 MR000374450309/20/202109/20/202109/21/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET903030100.00000Replenished 1001929791 3069291945