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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 000000787421 MR000711870001/05/202201/05/202201/05/202268001041504DULOXETINE HCL DR 60 MG CAP60 MGCAPSULE DR30903033.33300Replenished 1001985204 3079284650
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000787421 MR000711870001/05/202201/05/202201/05/202268001041504DULOXETINE HCL DR 60 MG CAP60 MGCAPSULE DR30903033.33300Replenished 1001985204 3079284650
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000787421 MR000711870001/05/202201/05/202201/05/202268001041504DULOXETINE HCL DR 60 MG CAP60 MGCAPSULE DR30903033.33400Replenished 1001985204 3079284650
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778516 MR002564910303/15/202103/15/202103/16/202168001041504DULOXETINE HCL DR 60 MG CAP60 MGCAPSULE DR303030100.00000Replenished 1001826768 3050065356
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778516 MR002564910404/12/202104/12/202104/13/202168001041504DULOXETINE HCL DR 60 MG CAP60 MGCAPSULE DR303030100.00000Replenished 1001842172 3052723058
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778516 MR002564910505/10/202105/10/202105/11/202168001041504DULOXETINE HCL DR 60 MG CAP60 MGCAPSULE DR303030100.00000Replenished 1001856282 3055381317
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778516 MR002564910606/02/202106/02/202106/03/202168001041504DULOXETINE HCL DR 60 MG CAP60 MGCAPSULE DR303030100.00000Replenished 1001868295 3057602223
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778516 MR002564910707/08/202107/08/202107/09/202168001041504DULOXETINE HCL DR 60 MG CAP60 MGCAPSULE DR303030100.00000Replenished 1001888054 3061086530
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778516 MR002564910808/09/202108/09/202108/10/202168001041504DULOXETINE HCL DR 60 MG CAP60 MGCAPSULE DR303030100.00000Replenished 1001902393 3064140711
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778604 MR002232670202/16/202102/16/202102/17/202168001041504DULOXETINE HCL DR 60 MG CAP60 MGCAPSULE DR30603050.00000Replenished 1001811909 987581092