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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 000000790487 MR001624700611/23/202211/23/202211/24/202265162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE100903943.33300Replenished 1002139267 3113875248
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790487 MR001624700611/23/202211/23/202211/24/202265162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE100905156.66700Replenished 1002139267 3113875248
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791155 MR000443660603/31/202303/31/202304/01/202365162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE1009090100.00000Replenished 1002198481 3129060211
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782200 143780510/22/202110/22/202110/23/202165162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE10030930.00000Replenished 1001947287 3071601883
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782200 143780510/22/202110/22/202110/23/202165162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE100302170.00000Replenished 1001951777 3072578295
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790487 MR001624700510/24/202210/24/202210/25/202265162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE1009090100.00000Replenished 1002125076 3110431983
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791155 MR000443660503/02/202303/02/202303/03/202365162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE100902123.33300Replenished 1002193992 3127402543
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791155 MR000443660503/02/202303/02/202303/03/202365162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE100906976.66700Replenished 1002184466 3125496601
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776042 MR001198520403/24/202103/24/202103/25/202165162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE100120108.33300Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776042 MR001198520403/24/202103/24/202103/25/202165162010210GABAPENTIN 300 MG CAPSULE300 MGCAPSULE1001203025.00000Replenished 1001831820 3050993427