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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 000000771634 MR002897470311/13/202011/13/202011/14/202016729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET100907077.77800Replenished 1001764760
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783446 MR001613010007/20/202107/20/202107/21/202116729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET1003030100.00000Replenished 1001950376 3072152538
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783446 MR001613010108/30/202108/30/202108/31/202116729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET1003030100.00000Replenished 1001950376 3072152538
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783446 MR001613010209/28/202109/28/202109/29/202116729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET1003030100.00000Replenished 1001950376 3072152538
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783446 MR001613010310/27/202110/27/202110/28/202116729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET100301033.33300Replenished 1001950376 3072152538
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783446 MR001613010310/27/202110/27/202110/28/202116729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET100302066.66700Replenished 1001991075 3080809434
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786389 MR001613010011/22/202111/22/202111/23/202116729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET1003030100.00000Replenished 1001991075 3080809434
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786826 MR002897470102/24/202202/24/202202/25/202216729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET100903033.33300Replenished 1002050106 3092568972
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786826 MR002897470102/24/202202/24/202202/25/202216729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET100906066.66700Replenished 1002011074 3084743907
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786826 MR002897470206/13/202206/13/202206/14/202216729017201AMITRIPTYLINE HCL 25 MG TAB25 MGTABLET100904044.44400Replenished 1002083390 3100621822