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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 000000786520 MR003890111010/01/202210/01/202210/02/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 241006060100.00000Replenished 1002119666 3108617906
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786520 MR003890111111/04/202211/04/202211/06/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 241006060100.00000Replenished 1002129142 3111671677
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788476 MR003261530311/17/202211/17/202211/18/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 241001808044.44400Replenished 1002138927 3113726126
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788476 MR003261530311/17/202211/17/202211/18/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 2410018010055.55600Replenished 1002137601 3113250051
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789871 MR000820700210/08/202210/08/202210/09/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 24100901011.11100Replenished 1002119666 3108617906
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789871 MR000820700210/08/202210/08/202210/09/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 24100908088.88900Replenished 1002124663 3110135018
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793024 MR002793580009/22/202209/22/202209/23/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 241003030100.00000Replenished 1002119666 3108617906
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793024 MR002793580110/22/202210/22/202210/23/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 24100301033.33300Replenished 1002129142 3111671677
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793024 MR002793580110/22/202210/22/202210/23/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 24100302066.66700Replenished 1002124663 3110135018
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793815 MR002232670010/27/202210/27/202210/28/202264980028101GLIPIZIDE ER 10 MG TABLET10 MGTAB ER2 241003030100.00000Replenished 1002129142 3111671677