Back

Accumulator - View By Claim

Export to Excel

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 000000795566 MR003063190001/19/202301/19/202301/19/202300054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished 1002165418 3120576240
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000796929 MR003063190003/27/202303/27/202303/27/202300054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished 1002195747 3128183260
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000798011 MR003063190005/17/202305/17/202305/17/202300054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished05/19/2023 1002221549 3133876132
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000798930 MR003063190007/03/202307/03/202307/03/202300054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished07/06/2023 1002240234 3138951860
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000799910 MR003063190008/23/202308/23/202308/23/202300054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished08/25/2023 1002262527 3144695754
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797384 MR003768460004/18/202304/18/202304/19/202300054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished04/20/2023 1002208939 3130655811
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797384 MR003768460107/18/202307/18/202307/19/202300054004544IPRATROPIUM 0.03% SPRAY21 MCGSPRAY303030100.00000Replenished08/22/2023 1002248589 3140519199