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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 000000795340 MR001825340102/25/202302/27/202303/01/202300093106001SOTALOL 120 MG TABLET120 MGTABLET1001202016.66700Replenished04/24/2023 1002209778 3130976966
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795340 MR001825340102/25/202302/27/202303/01/202300093106001SOTALOL 120 MG TABLET120 MGTABLET10012010083.33300Replenished 1002183817 3125156097
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795340 MR001825340204/21/202304/21/202304/22/202300093106001SOTALOL 120 MG TABLET120 MGTABLET1001204033.33300Replenished06/05/2023 1002226246 3135522746
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795340 MR001825340204/21/202304/21/202304/22/202300093106001SOTALOL 120 MG TABLET120 MGTABLET1001208066.66700Replenished04/24/2023 1002209778 3130976966
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795340 MR001825340305/30/202305/30/202306/01/202300093106001SOTALOL 120 MG TABLET120 MGTABLET1001206050.00000Replenished06/05/2023 1002226246 3135522746
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795340 MR001825340305/30/202305/30/202306/01/202300093106001SOTALOL 120 MG TABLET120 MGTABLET1001206050.00000Replenished08/22/2023 1002251223 3141466060
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000799384 MR001825340007/26/202307/26/202307/27/202300093106001SOTALOL 120 MG TABLET120 MGTABLET1001204033.33300Replenished08/22/2023 1002251223 3141466060