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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 000000779686 MR002911500002/05/202102/05/202102/06/202168462063945NITROGLYCERIN 0.4 MG TABLET SL0.4 MGTAB SUBL1002525100.00000Replenished 1001935094 3069471044
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780552 MR001393520003/15/202103/15/202103/16/202168462063945NITROGLYCERIN 0.4 MG TABLET SL0.4 MGTAB SUBL1002525100.00000Replenished 1001935094 3069471044
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783513 MR001650040007/22/202107/22/202107/23/202168462063945NITROGLYCERIN 0.4 MG TABLET SL0.4 MGTAB SUBL1002525100.00000Replenished 1001935094 3069471044
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785204 14440010/01/202110/01/202110/02/202168462063945NITROGLYCERIN 0.4 MG TABLET SL0.4 MGTAB SUBL1002525100.00000Replenished 1001935094 3069471044
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786149 MR001650040011/09/202111/09/202111/10/202168462063945NITROGLYCERIN 0.4 MG TABLET SL0.4 MGTAB SUBL1002525100.00000Replenished 1001978209 3078024705
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787121 MR001847900012/22/202112/22/202112/23/202168462063945NITROGLYCERIN 0.4 MG TABLET SL0.4 MGTAB SUBL1001002525.00000Replenished 1002072694 3097384160
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787121 MR001847900012/22/202112/22/202112/23/202168462063945NITROGLYCERIN 0.4 MG TABLET SL0.4 MGTAB SUBL1001007575.00000Replenished 1001978209 3078024705
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788917 MR002965900003/15/202203/15/202203/16/202268462063945NITROGLYCERIN 0.4 MG TABLET SL0.4 MGTAB SUBL1002525100.00000Replenished 1002072694 3097384160
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790465 MR002965900005/24/202205/24/202205/25/202268462063945NITROGLYCERIN 0.4 MG TABLET SL0.4 MGTAB SUBL1002525100.00000Replenished 1002072694 3097384160
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791052 MR002341130006/22/202206/22/202206/23/202268462063945NITROGLYCERIN 0.4 MG TABLET SL0.4 MGTAB SUBL1002525100.00000Replenished 1002072694 3097384160