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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)Cash 340B 000000795966 MR002793580002/07/202302/07/202302/07/202300006011231JANUVIA 50 MG TABLET50 MGTABLET303030100.00000Replenished 1002175801 3122701271
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000795966 MR002793580103/03/202303/03/202303/03/202300006011231JANUVIA 50 MG TABLET50 MGTABLET303030100.00000Replenished 1002184819 3125496603
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000795966 MR002793580203/29/202303/29/202303/29/202300006011231JANUVIA 50 MG TABLET50 MGTABLET303030100.00000Replenished 1002197281 3128472397
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778102 MR000303240102/22/202102/22/202102/23/202100006011231JANUVIA 50 MG TABLET50 MGTABLET30903033.33300Replenished 1001816056 987916714
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778102 MR000303240102/22/202102/22/202102/23/202100006011231JANUVIA 50 MG TABLET50 MGTABLET30903033.33300Replenished 1001816056 987916714
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778102 MR000303240102/22/202102/22/202102/23/202100006011231JANUVIA 50 MG TABLET50 MGTABLET30903033.33400Replenished 1001816056 987916714
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000795966 MR002793580305/15/202305/15/202305/15/202300006011231JANUVIA 50 MG TABLET50 MGTABLET303030100.00000Replenished06/01/2023 1002225877 3135192766