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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 000000775453 MR002937890201/26/202101/26/202101/27/202100173068220VENTOLIN HFA 90 MCG INHALER90 MCGHFA AER AD18187.541.66700Replenished 1001846719 3053644954
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775453 MR002937890201/26/202101/26/202101/27/202100173068220VENTOLIN HFA 90 MCG INHALER90 MCGHFA AER AD181810.558.33300Replenished 1001802067
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779708 MR000206680111/08/202111/08/202111/09/202100173068220VENTOLIN HFA 90 MCG INHALER90 MCGHFA AER AD18187.541.66700Replenished 1001965091 3075301281
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779708 MR000206680111/08/202111/08/202111/09/202100173068220VENTOLIN HFA 90 MCG INHALER90 MCGHFA AER AD181810.558.33300Replenished 1001956102 3073301294
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781344 MR002408980004/20/202104/20/202104/21/202100173068220VENTOLIN HFA 90 MCG INHALER90 MCGHFA AER AD18187.541.66700Replenished 1001865893 3057164796
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781344 MR002408980004/20/202104/20/202104/21/202100173068220VENTOLIN HFA 90 MCG INHALER90 MCGHFA AER AD181810.558.33300Replenished 1001846719 3053644954
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782253 MR002937890005/27/202105/27/202105/28/202100173068220VENTOLIN HFA 90 MCG INHALER90 MCGHFA AER AD18187.541.66700Replenished 1001916855 3066262939
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782253 MR002937890005/27/202105/27/202105/28/202100173068220VENTOLIN HFA 90 MCG INHALER90 MCGHFA AER AD181810.558.33300Replenished 1001865893 3057164796
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784383 MR002000110008/30/202108/30/202108/31/202100173068220VENTOLIN HFA 90 MCG INHALER90 MCGHFA AER AD18187.541.66700Replenished 1001917809 3066693686
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784383 MR002000110008/30/202108/30/202108/31/202100173068220VENTOLIN HFA 90 MCG INHALER90 MCGHFA AER AD181810.558.33300Replenished 1001916855 3066262939