Back

Accumulator - View By Claim

Export to Excel

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 000000778631 MR002798370012/17/202012/17/202012/18/202000143980350DOXYCYCLINE HYCLATE 100 MG CAP100 MGCAPSULE5010440.00000Replenished 1001780016
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778631 MR002798370012/17/202012/17/202012/18/202000143980350DOXYCYCLINE HYCLATE 100 MG CAP100 MGCAPSULE5010660.00000Replenished 1001874950 3058793435
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781972 MR001503990106/15/202106/15/202106/16/202100143980350DOXYCYCLINE HYCLATE 100 MG CAP100 MGCAPSULE50301033.33300Replenished 1001874950 3058793435
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781972 MR001503990106/15/202106/15/202106/16/202100143980350DOXYCYCLINE HYCLATE 100 MG CAP100 MGCAPSULE50302066.66700Replenished 1001890275 3061781565
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781972 MR001503990207/15/202107/15/202107/16/202100143980350DOXYCYCLINE HYCLATE 100 MG CAP100 MGCAPSULE503030100.00000Replenished 1001890275 3061781565
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781972 MR001503990308/16/202108/16/202108/17/202100143980350DOXYCYCLINE HYCLATE 100 MG CAP100 MGCAPSULE503030100.00000Replenished 1001917460 3066543102
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781972 MR001503990409/20/202109/20/202109/21/202100143980350DOXYCYCLINE HYCLATE 100 MG CAP100 MGCAPSULE50301240.00000Replenished 1001939387 3070573301
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781972 MR001503990409/20/202109/20/202109/21/202100143980350DOXYCYCLINE HYCLATE 100 MG CAP100 MGCAPSULE50301860.00000Replenished 1001925175 3068316933
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781972 MR001503990510/28/202110/28/202110/29/202100143980350DOXYCYCLINE HYCLATE 100 MG CAP100 MGCAPSULE5030826.66700Replenished 1001951026 3072312986
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781972 MR001503990510/28/202110/28/202110/29/202100143980350DOXYCYCLINE HYCLATE 100 MG CAP100 MGCAPSULE50302273.33300Replenished 1001963534 3074872858