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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 000000783789 MR000588010008/13/202108/13/202109/03/202164764073030TRINTELLIX 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001917809 3066693686
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783789 MR000588010109/16/202109/16/202109/18/202164764073030TRINTELLIX 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001924438 3068049381
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783789 MR000588010210/18/202110/18/202110/20/202164764073030TRINTELLIX 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001945703 3071287759
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782678 MR000588010107/21/202107/21/202108/05/202164764073030TRINTELLIX 10 MG TABLET10 MGTABLET303030100.00000Replenished 1001899897 3063887299