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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 000000791794 MR001128430007/27/202207/27/202207/28/202200032122401CREON DR 24,000 UNIT CAPSULE24-76-120KCAPSULE DR100100100100.00000Replenished 1002084916 3100895806
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791794 MR001128430108/29/202208/29/202208/30/202200032122401CREON DR 24,000 UNIT CAPSULE24-76-120KCAPSULE DR100100100100.00000Replenished 1002099121 3104604852
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791794 MR001128430210/17/202210/17/202210/18/202200032122401CREON DR 24,000 UNIT CAPSULE24-76-120KCAPSULE DR100100100100.00000Replenished 1002123446 3109811595
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791794 MR001128430311/29/202211/29/202211/30/202200032122401CREON DR 24,000 UNIT CAPSULE24-76-120KCAPSULE DR100100100100.00000Replenished 1002141685 3114387690
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791794 MR001128430401/27/202301/27/202301/28/202300032122401CREON DR 24,000 UNIT CAPSULE24-76-120KCAPSULE DR100100100100.00000Replenished 1002168592 3121399810
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791794 MR001128430503/18/202303/18/202303/19/202300032122401CREON DR 24,000 UNIT CAPSULE24-76-120KCAPSULE DR100100100100.00000Replenished 1002193454 3127106974