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 000000776785 MR003927551009/07/202109/07/202109/08/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001919113 3067013098
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792895 MR003927551007/06/202307/06/202307/07/202370700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished08/22/2023 1002248399 3140374263
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776785 MR003927550908/09/202108/09/202108/10/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001919113 3067013098
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792895 MR003927550906/12/202306/12/202306/13/202370700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished06/14/2023 1002233505 3136619883
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776785 MR003927550807/12/202107/12/202107/13/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001891615 3062304712
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792895 MR003927550805/15/202305/15/202305/16/202370700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished06/14/2023 1002233505 3136619883
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776785 MR003927550706/14/202106/14/202106/15/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001891615 3062304712
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792895 MR003927550704/14/202304/14/202304/15/202370700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished06/14/2023 1002233505 3136619883
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776785 MR003927550605/17/202105/17/202105/18/202170700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001854421 3055134799
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792895 MR003927550603/17/202303/17/202303/18/202370700011985ESTARYLLA 0.25-0.035 MG TABLET0.25-0.035TABLET842828100.00000Replenished 1001796904