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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)Cash 340B 000000793352 MR000259870010/05/202210/05/202210/05/202268382013201TAMSULOSIN HCL 0.4 MG CAPSULE0.4 MGCAPSULE1003030100.00000Replenished 1002123446 3109811595
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000771602 MR002232670502/05/202102/05/202102/06/202168382013201TAMSULOSIN HCL 0.4 MG CAPSULE0.4 MGCAPSULE1003030100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774595 MR000069230304/12/202104/12/202104/13/202168382013201TAMSULOSIN HCL 0.4 MG CAPSULE0.4 MGCAPSULE100904145.55600Replenished 1001842172 3052723058
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774595 MR000069230304/12/202104/12/202104/13/202168382013201TAMSULOSIN HCL 0.4 MG CAPSULE0.4 MGCAPSULE100904954.44400Replenished 1001842802 3052853627
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775187 MR000952170202/10/202102/10/202102/11/202168382013201TAMSULOSIN HCL 0.4 MG CAPSULE0.4 MGCAPSULE1009044.44400Replenished 1001826768 3050065356
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775187 MR000952170202/10/202102/10/202102/11/202168382013201TAMSULOSIN HCL 0.4 MG CAPSULE0.4 MGCAPSULE100901617.77800Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775187 MR000952170202/10/202102/10/202102/11/202168382013201TAMSULOSIN HCL 0.4 MG CAPSULE0.4 MGCAPSULE100907077.77800Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775187 MR000952170305/04/202105/04/202105/05/202168382013201TAMSULOSIN HCL 0.4 MG CAPSULE0.4 MGCAPSULE100902932.22200Replenished 1001857662 3055508681
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775187 MR000952170305/04/202105/04/202105/05/202168382013201TAMSULOSIN HCL 0.4 MG CAPSULE0.4 MGCAPSULE100906167.77800Replenished 1001852121 3054859692
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777800 MR003863660302/08/202102/08/202102/09/202168382013201TAMSULOSIN HCL 0.4 MG CAPSULE0.4 MGCAPSULE1003030100.00000Replenished 1001811232 987509358