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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 000000780649 MR001011130003/19/202103/19/202103/20/202151672402801WARFARIN SODIUM 2 MG TABLET2 MGTABLET100301033.33300Replenished 1001829373 3050481049
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782486 MR002044000006/07/202106/07/202106/08/202151672402801WARFARIN SODIUM 2 MG TABLET2 MGTABLET100301033.33300Replenished 1001911378 3066004376
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786148 MR002044000011/09/202111/09/202111/10/202151672402801WARFARIN SODIUM 2 MG TABLET2 MGTABLET100301033.33300Replenished 1001956560 3073437016
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788681 MR002044000003/03/202203/03/202203/04/202251672402801WARFARIN SODIUM 2 MG TABLET2 MGTABLET100301033.33300Replenished 1002065805 3095834365
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794099 MR002044000011/09/202211/09/202211/10/202251672402801WARFARIN SODIUM 2 MG TABLET2 MGTABLET100301033.33300Replenished 1002130385 3112283351
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780649 MR001011130003/19/202103/19/202103/20/202151672402801WARFARIN SODIUM 2 MG TABLET2 MGTABLET100302066.66700Replenished 1001871163 3057980095
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782486 MR002044000006/07/202106/07/202106/08/202151672402801WARFARIN SODIUM 2 MG TABLET2 MGTABLET100302066.66700Replenished 1001871163 3057980095
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786148 MR002044000011/09/202111/09/202111/10/202151672402801WARFARIN SODIUM 2 MG TABLET2 MGTABLET100302066.66700Replenished 1002015325 3085493191
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788681 MR002044000003/03/202203/03/202203/04/202251672402801WARFARIN SODIUM 2 MG TABLET2 MGTABLET100302066.66700Replenished 1002015325 3085493191
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778738 MR000380130102/08/202102/08/202102/09/202151672402801WARFARIN SODIUM 2 MG TABLET2 MGTABLET1003030100.00000Replenished 1001829373 3050481049