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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 000000774285 MR000919760706/07/202106/07/202106/08/202169680013400POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA100602033.33300Replenished 1001871163 3057980095
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774285 MR000919760706/07/202106/07/202106/08/202169680013400POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA100604066.66700Replenished 1001876050 3059092759
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777476 MR001741360204/30/202104/30/202105/01/202169680013400POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA100902022.22200Replenished 1001871163 3057980095
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777476 MR001741360204/30/202104/30/202105/01/202169680013400POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA100907077.77800Replenished 1001850989 3054468652
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777476 MR001741360307/28/202107/28/202107/29/202169680013400POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA100903033.33300Replenished 1001897770 3062993331
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777476 MR001741360307/28/202107/28/202107/29/202169680013400POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA100906066.66700Replenished 1001903802 3064589183
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778337 MR002588990206/17/202106/17/202106/18/202169680013400POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA1001802011.11100Replenished 1001883113 3060162693
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778337 MR002588990206/17/202106/17/202106/18/202169680013400POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA1001806033.33300Replenished 1001876050 3059092759
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778337 MR002588990206/17/202106/17/202106/18/202169680013400POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA10018010055.55600Replenished 1001876050 3059092759
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778337 MR002588990309/09/202109/09/202109/10/202169680013400POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA1001803016.66600Replenished 1001928804 3069023028