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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 000000780534 MR001082060205/12/202105/12/202105/13/202169097040707METOPROLOL SUCC ER 50 MG TAB50 MGTAB.SR 24H1003030100.00000Replenished 1001863873 3056827847
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781966 MR001655310005/15/202105/15/202105/16/202169097040707METOPROLOL SUCC ER 50 MG TAB50 MGTAB.SR 24H1003030100.00000Replenished 1001863873 3056827847
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782052 MR003766730005/19/202105/19/202105/20/202169097040707METOPROLOL SUCC ER 50 MG TAB50 MGTAB.SR 24H1003030100.00000Replenished 1001863873 3056827847
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782161 MR003219920005/24/202105/24/202105/25/202169097040707METOPROLOL SUCC ER 50 MG TAB50 MGTAB.SR 24H100301033.33300Replenished 1001863873 3056827847
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782075 MR001655310006/14/202106/14/202106/15/202169097040707METOPROLOL SUCC ER 50 MG TAB50 MGTAB.SR 24H100302066.66700Replenished 1001877216 3059199453
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782161 MR003219920005/24/202105/24/202105/25/202169097040707METOPROLOL SUCC ER 50 MG TAB50 MGTAB.SR 24H100302066.66700Replenished 1001877216 3059199453
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782186 MR001174460005/26/202105/26/202105/27/202169097040707METOPROLOL SUCC ER 50 MG TAB50 MGTAB.SR 24H1006060100.00000Replenished 1001877216 3059199453
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779826 MR000952170106/17/202106/17/202106/18/202169097040707METOPROLOL SUCC ER 50 MG TAB50 MGTAB.SR 24H1009090100.00000Replenished 1001880371 3059776595
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782075 MR001655310006/14/202106/14/202106/15/202169097040707METOPROLOL SUCC ER 50 MG TAB50 MGTAB.SR 24H100301033.33300Replenished 1001880371 3059776595
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780534 MR001082060306/18/202106/18/202106/19/202169097040707METOPROLOL SUCC ER 50 MG TAB50 MGTAB.SR 24H1003030100.00000Replenished 1001882607 3060033992