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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 000000771431 MR002257040301/29/202101/29/202101/30/202162175012837ISOSORBIDE MONONIT ER 30 MG TB30 MGTAB.SR 24H100902022.22200Replenished 1001847629 3053810031
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000771431 MR002257040301/29/202101/29/202101/30/202162175012837ISOSORBIDE MONONIT ER 30 MG TB30 MGTAB.SR 24H100907077.77800Replenished 1001803996
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774521 MR000952170702/20/202102/20/202102/21/202162175012837ISOSORBIDE MONONIT ER 30 MG TB30 MGTAB.SR 24H1003030100.00000Replenished 1001847629 3053810031
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774521 MR000952170803/18/202103/18/202103/19/202162175012837ISOSORBIDE MONONIT ER 30 MG TB30 MGTAB.SR 24H1003030100.00000Replenished 1001847629 3053810031
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774521 MR000952170904/22/202104/22/202104/23/202162175012837ISOSORBIDE MONONIT ER 30 MG TB30 MGTAB.SR 24H100301033.33300Replenished 1001890605 3061781567
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774521 MR000952170904/22/202104/22/202104/23/202162175012837ISOSORBIDE MONONIT ER 30 MG TB30 MGTAB.SR 24H100302066.66700Replenished 1001847629 3053810031
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774521 MR000952171005/18/202105/18/202105/19/202162175012837ISOSORBIDE MONONIT ER 30 MG TB30 MGTAB.SR 24H1003030100.00000Replenished 1001890605 3061781567
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774521 MR000952171106/17/202106/17/202106/18/202162175012837ISOSORBIDE MONONIT ER 30 MG TB30 MGTAB.SR 24H1003030100.00000Replenished 1001890605 3061781567
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783384 MR000952170007/16/202107/16/202107/17/202162175012837ISOSORBIDE MONONIT ER 30 MG TB30 MGTAB.SR 24H1003030100.00000Replenished 1001890605 3061781567
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784209 MR000952170008/20/202108/20/202108/21/202162175012837ISOSORBIDE MONONIT ER 30 MG TB30 MGTAB.SR 24H1003030100.00000Replenished 1001962155 3074468468