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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 000000774556 MR002420680803/01/202103/01/202103/02/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100301240.00000Replenished 1001822785 3049139689
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774556 MR002420680903/31/202103/31/202104/01/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1003030100.00000Replenished 1001835626 3051655272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774556 MR002420681004/30/202104/30/202105/01/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1003030100.00000Replenished 1001850989 3054468652
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774556 MR002420681106/01/202106/01/202106/02/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1003030100.00000Replenished 1001867724 3057523425
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774597 MR000069230304/12/202104/12/202104/13/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100902022.22200Replenished 1001842802 3052853627
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774597 MR000069230304/12/202104/12/202104/13/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100907077.77800Replenished 1001842172 3052723058
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774643 MR000790050304/29/202104/29/202104/30/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1001803217.77700Replenished 1001854421 3055134799
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774643 MR000790050304/29/202104/29/202104/30/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1001804826.66700Replenished 1001850989 3054468652
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774643 MR000790050304/29/202104/29/202104/30/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR10018010055.55600Replenished 1001850989 3054468652
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774929 MR001709230006/01/202106/01/202106/02/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR10018021.11100Replenished 1001871163 3057980095