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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 000000789219 MR000729920107/13/202207/13/202207/14/202268001045600ESCITALOPRAM 20 MG TABLET20 MGTABLET100901011.11100Replenished 1002079953 3099393355
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789219 MR000729920107/13/202207/13/202207/14/202268001045600ESCITALOPRAM 20 MG TABLET20 MGTABLET100908088.88900Replenished 1002082948 3100356573
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789469 MR000443660206/27/202206/27/202206/28/202268001045600ESCITALOPRAM 20 MG TABLET20 MGTABLET1003030100.00000Replenished 1002079953 3099393355
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789469 MR000443660307/30/202207/30/202207/31/202268001045600ESCITALOPRAM 20 MG TABLET20 MGTABLET1003030100.00000Replenished 1002095045 3103220465
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789469 MR000443660408/30/202208/30/202209/01/202268001045600ESCITALOPRAM 20 MG TABLET20 MGTABLET1003030100.00000Replenished 1002118447 3108304458
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789469 MR000443660510/05/202210/05/202210/06/202268001045600ESCITALOPRAM 20 MG TABLET20 MGTABLET1003030100.00000Replenished 1002129142 3111671677
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789469 MR000443660611/05/202211/05/202211/06/202268001045600ESCITALOPRAM 20 MG TABLET20 MGTABLET100301033.33300Replenished 1002148126 3115671277
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789469 MR000443660611/05/202211/05/202211/06/202268001045600ESCITALOPRAM 20 MG TABLET20 MGTABLET100302066.66700Replenished 1002129142 3111671677
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789469 MR000443660712/10/202212/10/202212/11/202268001045600ESCITALOPRAM 20 MG TABLET20 MGTABLET1003030100.00000Replenished 1002148126 3115671277
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789469 MR000443660801/10/202301/10/202301/11/202368001045600ESCITALOPRAM 20 MG TABLET20 MGTABLET100301033.33300Replenished 1002162186 3119565263