Back

Accumulator - View By Claim

Export to Excel

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 000000794665 MR003883610202/06/202302/06/202302/11/202360505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET100302583.33300Replenished 1002178117 3123055057
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794665 MR003883610101/09/202301/09/202301/10/202360505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1003030100.00000Replenished 1002178117 3123055057
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794665 MR003883610012/05/202212/05/202212/06/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1003030100.00000Replenished 1002178117 3123055057
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794071 MR003883610011/08/202211/08/202211/09/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET100301550.00000Replenished 1002130060 3112131940
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794071 MR003883610011/08/202211/08/202211/09/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET100301550.00000Replenished 1002178117 3123055057
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791433 MR003883610310/12/202210/12/202210/13/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1003030100.00000Replenished 1002130060 3112131940
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785594 MR002897470210/03/202210/03/202210/04/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1004545100.00000Replenished 1002130060 3112131940
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791433 MR003883610209/06/202209/06/202209/09/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET100301033.33300Replenished 1002130060 3112131940
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791433 MR003883610209/06/202209/06/202209/09/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET100302066.66700Replenished 1002102296 3105614642
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791433 MR003883610108/10/202208/10/202208/11/202260505265701TRIAMTERENE-HCTZ 75-50 MG TAB75 MG-50MGTABLET1003030100.00000Replenished 1002102296 3105614642