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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 000000779622 BBG9FRG6YEC40002/04/202102/04/202102/06/202159746021701SPIRONOLACTONE 50 MG TABLET50 MGTABLET1003030100.00000Replenished 1001856282 3055381317
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784872 MR002183130009/16/202109/16/202109/17/202159746021701SPIRONOLACTONE 50 MG TABLET50 MGTABLET100905055.55600Replenished 1001924089 3068049380
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779622 BBG9FRG6YEC40103/08/202103/08/202103/09/202159746021701SPIRONOLACTONE 50 MG TABLET50 MGTABLET1003030100.00000Replenished 1001856282 3055381317
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779622 BBG9FRG6YEC40204/12/202104/12/202104/13/202159746021701SPIRONOLACTONE 50 MG TABLET50 MGTABLET1003030100.00000Replenished 1001856282 3055381317
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779622 BBG9FRG6YEC40305/10/202105/10/202105/11/202159746021701SPIRONOLACTONE 50 MG TABLET50 MGTABLET100301033.33300Replenished 1001856282 3055381317
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779622 BBG9FRG6YEC40305/10/202105/10/202105/11/202159746021701SPIRONOLACTONE 50 MG TABLET50 MGTABLET100302066.66700Replenished 1001924089 3068049380
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779622 BBG9FRG6YEC40406/15/202106/15/202106/16/202159746021701SPIRONOLACTONE 50 MG TABLET50 MGTABLET1003030100.00000Replenished 1001924089 3068049380