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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 000004012014 MR002045690506/29/202206/29/202207/01/202259762371901ALPRAZOLAM 0.25 MG TABLET0.25 MGTABLET100100100100.00000Replenished 1002075533 3098184650
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012564 MR002045690507/28/202307/28/202307/29/202359762371901ALPRAZOLAM 0.25 MG TABLET0.25 MGTABLET1001202420.00000Replenished08/22/2023 1002251766 3141657238
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012564 MR002045690507/28/202307/28/202307/29/202359762371901ALPRAZOLAM 0.25 MG TABLET0.25 MGTABLET1001209680.00000Replenished08/16/2023 1002259761 3143593677
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012564 MR002045690406/22/202306/22/202306/23/202359762371901ALPRAZOLAM 0.25 MG TABLET0.25 MGTABLET1001202016.66700Replenished08/22/2023 1002251766 3141657238
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012564 MR002045690406/22/202306/22/202306/23/202359762371901ALPRAZOLAM 0.25 MG TABLET0.25 MGTABLET10012010083.33300Replenished06/26/2023 1002236912 3137855545
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012564 MR002045690305/15/202305/15/202305/16/202359762371901ALPRAZOLAM 0.25 MG TABLET0.25 MGTABLET1001202016.66700Replenished06/16/2023 1002234551 3136912239
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012564 MR002045690305/15/202305/15/202305/16/202359762371901ALPRAZOLAM 0.25 MG TABLET0.25 MGTABLET10012010083.33300Replenished05/18/2023 1002221191 3133750054
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012290 MR002045690210/03/202210/03/202210/04/202259762371901ALPRAZOLAM 0.25 MG TABLET0.25 MGTABLET1001002020.00000Replenished 1002147857 3115655015
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012290 MR002045690210/03/202210/03/202210/04/202259762371901ALPRAZOLAM 0.25 MG TABLET0.25 MGTABLET1001008080.00000Replenished 1002164575 3120074503
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004012564 MR002045690204/14/202304/14/202304/15/202359762371901ALPRAZOLAM 0.25 MG TABLET0.25 MGTABLET10012086.66700Replenished04/17/2023 1002208015 3130202879