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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 000000775452 MR003219920502/12/202102/12/202102/13/202168180021509LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET903030100.00000Replenished 1001812276 987651857
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779576 MR002771770002/01/202102/01/202102/02/202168180021509LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET90903033.33300Replenished 1001812276 987651857
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779576 MR002771770002/01/202102/01/202102/02/202168180021509LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET90906066.66700Replenished 1001805758
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779576 MR002771770105/04/202105/04/202105/05/202168180021509LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET909090100.00000Replenished 1001852121 3054859692
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779576 MR002771770208/09/202108/09/202108/10/202168180021509LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET909090100.00000Replenished 1001902393 3064140711
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779979 MR000171950002/17/202102/17/202102/18/202168180021509LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET903030100.00000Replenished 1001812276 987651857
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780594 MR002684010003/16/202103/16/202103/17/202168180021509LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET909090100.00000Replenished 1001827193 3050193216
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780594 MR002684010106/25/202106/25/202106/26/202168180021509LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET90903033.33300Replenished 1001880371 3059776595
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780594 MR002684010106/25/202106/25/202106/26/202168180021509LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET90906066.66700Replenished 1001890605 3061781567
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780594 MR002684010209/21/202109/21/202109/22/202168180021509LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET90903033.33300Replenished 1001926498 3068455122