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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 000000789481 MR001825340004/11/202204/11/202204/12/202200093342601LORAZEPAM 1 MG TABLET1 MGTABLET100561221.42900Replenished 1002065210 3095834362
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789481 MR001825340004/11/202204/11/202204/12/202200093342601LORAZEPAM 1 MG TABLET1 MGTABLET100564478.57100Replenished 1002033642 3089441265
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790144 MR001825340005/10/202205/10/202205/11/202200093342601LORAZEPAM 1 MG TABLET1 MGTABLET1005656100.00000Replenished 1002065210 3095834362
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790772 MR001825340006/08/202206/08/202206/09/202200093342601LORAZEPAM 1 MG TABLET1 MGTABLET100562442.85700Replenished 1002087704 3101872454
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790772 MR001825340006/08/202206/08/202206/09/202200093342601LORAZEPAM 1 MG TABLET1 MGTABLET100563257.14300Replenished 1002065210 3095834362
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791394 MR001825340007/07/202207/07/202207/08/202200093342601LORAZEPAM 1 MG TABLET1 MGTABLET1005656100.00000Replenished 1002087704 3101872454
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792027 MR001825340008/06/202208/06/202208/07/202200093342601LORAZEPAM 1 MG TABLET1 MGTABLET100562035.71400Replenished 1002087704 3101872454
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792027 MR001825340008/06/202208/06/202208/07/202200093342601LORAZEPAM 1 MG TABLET1 MGTABLET100563664.28600Replenished 1002113582 3107872086
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792642 MR001825340009/02/202209/02/202209/03/202200093342601LORAZEPAM 1 MG TABLET1 MGTABLET1005656100.00000Replenished 1002113582 3107872086
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793180 MR001825340009/29/202209/29/202210/01/202200093342601LORAZEPAM 1 MG TABLET1 MGTABLET10056814.28600Replenished 1002113582 3107872086