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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 000000776146 MR000562130502/09/202102/09/202102/10/202170010049101METFORMIN HCL ER 500 MG TABLET500 MGTAB.SR 24H100602033.33300Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776146 MR000562130502/09/202102/09/202102/10/202170010049101METFORMIN HCL ER 500 MG TABLET500 MGTAB.SR 24H100604066.66700Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776146 MR000562130603/10/202103/10/202103/11/202170010049101METFORMIN HCL ER 500 MG TABLET500 MGTAB.SR 24H1006060100.00000Replenished 1001825446 3049810902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776146 MR000562130704/05/202104/05/202104/07/202170010049101METFORMIN HCL ER 500 MG TABLET500 MGTAB.SR 24H100602033.33300Replenished 1001839679 3052473904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776146 MR000562130704/05/202104/05/202104/07/202170010049101METFORMIN HCL ER 500 MG TABLET500 MGTAB.SR 24H100604066.66700Replenished 1001838628 3052278967
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777377 MR003261530204/17/202104/17/202104/18/202170010049101METFORMIN HCL ER 500 MG TABLET500 MGTAB.SR 24H1003607019.44400Replenished 1001844901 3053146135
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777377 MR003261530204/17/202104/17/202104/18/202170010049101METFORMIN HCL ER 500 MG TABLET500 MGTAB.SR 24H1003609025.00000Replenished 1001849752 3054181639
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777377 MR003261530204/17/202104/17/202104/18/202170010049101METFORMIN HCL ER 500 MG TABLET500 MGTAB.SR 24H10036010027.77800Replenished 1001844901 3053146135
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777377 MR003261530204/17/202104/17/202104/18/202170010049101METFORMIN HCL ER 500 MG TABLET500 MGTAB.SR 24H10036010027.77800Replenished 1001844901 3053146135
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777377 MR003261530307/12/202107/12/202107/13/202170010049101METFORMIN HCL ER 500 MG TABLET500 MGTAB.SR 24H100360102.77800Replenished 1001889250 3061354275