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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 000000774863 MR000952171107/08/202107/08/202107/19/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60601016.66700Replenished 1001891373 3062039555
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774863 MR000952171107/08/202107/08/202107/19/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60605083.33300Replenished 1001891615 3062304712
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774754 MR000606041006/21/202106/21/202106/22/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60601016.66700Replenished 1001877828 3059333148
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774754 MR000606041006/21/202106/21/202106/22/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60605083.33300Replenished 1001882607 3060033992
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774863 MR000952171006/03/202106/03/202106/15/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60601016.66700Replenished 1001874950 3058793435
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774863 MR000952171006/03/202106/03/202106/15/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60605083.33300Replenished 1001877828 3059333148
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776281 MR003879371008/24/202108/24/202108/25/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60602033.33300Replenished 1001915815 3066004377
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776281 MR003879371008/24/202108/24/202108/25/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60604066.66700Replenished 1001911051 3065829943
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774754 MR000606040905/24/202105/24/202105/25/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60601016.66700Replenished 1001863873 3056827847
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774754 MR000606040905/24/202105/24/202105/25/202100003089421ELIQUIS 5 MG TABLET5 MGTABLET60605083.33300Replenished 1001864958 3056990723