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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 000004011122 18820012/10/202012/10/202012/11/202000406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100901011.11100Replenished 1001833661 3051191520
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011354 MR000255130003/26/202103/26/202103/28/202100406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100401025.00000Replenished 1001833661 3051191520
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011354 MR000255130003/26/202103/26/202103/28/202100406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100401025.00000Replenished 1001833661 3051191520
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011506 18820006/02/202106/02/202106/03/202100406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100901011.11100Replenished 1001900472 3063887830
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011810 18820010/18/202110/18/202110/19/202100406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100901011.11100Replenished 1002033642 3089441265
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012112 MR000255130004/11/202204/11/202204/12/202200406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100401025.00000Replenished 1002033642 3089441265
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012406 MR000255130010/24/202210/24/202210/25/202200406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100401025.00000Replenished 1001777465
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012649 MR000255130004/25/202304/25/202304/26/202300406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100401025.00000Replenished04/26/2023 1001777465
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011354 MR000255130003/26/202103/26/202103/28/202100406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100402050.00000Replenished 1001868295 3057602222
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011763 18820009/27/202109/27/202109/28/202100406048401ACETAMINOPHEN-COD #3 TABLET300MG-30MGTABLET100902022.22200Replenished 1001945251 3071148262