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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 000000794271 MR003691350011/17/202211/17/202211/18/202268001045006ZIPRASIDONE HCL 20 MG CAPSULE20 MGCAPSULE601806033.33300Replenished 1002137601 3113250051
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794271 MR003691350011/17/202211/17/202211/18/202268001045006ZIPRASIDONE HCL 20 MG CAPSULE20 MGCAPSULE601806033.33300Replenished 1002137601 3113250051
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794271 MR003691350011/17/202211/17/202211/18/202268001045006ZIPRASIDONE HCL 20 MG CAPSULE20 MGCAPSULE601806033.33400Replenished 1002137601 3113250051
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792331 MR003691350210/24/202210/24/202210/25/202268001045006ZIPRASIDONE HCL 20 MG CAPSULE20 MGCAPSULE606060100.00000Replenished 1002125076 3110431983
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793407 MR002538330010/07/202210/07/202210/08/202268001045006ZIPRASIDONE HCL 20 MG CAPSULE20 MGCAPSULE606060100.00000Replenished 1002119397 3108617905
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792331 MR003691350109/26/202209/26/202209/27/202268001045006ZIPRASIDONE HCL 20 MG CAPSULE20 MGCAPSULE606060100.00000Replenished 1002112616 3107562830
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792331 MR003691350008/22/202208/22/202208/25/202268001045006ZIPRASIDONE HCL 20 MG CAPSULE20 MGCAPSULE606060100.00000Replenished 1002096808 3104187393
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784762 MR003691350009/13/202109/13/202109/14/202168001045006ZIPRASIDONE HCL 20 MG CAPSULE20 MGCAPSULE606060100.00000Replenished 1001923041 3067590209