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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)Cash 340B 000000782487 MR002109290006/07/202106/07/202106/07/202100173071620ADVAIR HFA 115-21 MCG INHALER115-21MCGHFA AER AD121212100.00000Replenished 1001871163 3057980095
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000782487 MR002109290107/07/202107/07/202107/07/202100173071620ADVAIR HFA 115-21 MCG INHALER115-21MCGHFA AER AD121212100.00000Replenished 1001886700 3060956655
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000782487 MR002109290208/16/202108/16/202108/16/202100173071620ADVAIR HFA 115-21 MCG INHALER115-21MCGHFA AER AD121212100.00000Replenished 1001904997 3064847322
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000784998 MR002109290009/22/202109/22/202109/22/202100173071620ADVAIR HFA 115-21 MCG INHALER115-21MCGHFA AER AD121212100.00000Replenished 1001927409 3068590036
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000784998 MR002109290111/22/202111/22/202111/22/202100173071620ADVAIR HFA 115-21 MCG INHALER115-21MCGHFA AER AD121212100.00000Replenished 1001963244 3074735172
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000784998 MR002109290212/22/202112/22/202112/22/202100173071620ADVAIR HFA 115-21 MCG INHALER115-21MCGHFA AER AD121212100.00000Replenished 1001977713 3078024703
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000784998 MR002109290301/24/202201/24/202201/24/202200173071620ADVAIR HFA 115-21 MCG INHALER115-21MCGHFA AER AD121212100.00000Replenished 1001994028 3081275297
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000788722 MR002109290003/04/202203/04/202203/04/202200173071620ADVAIR HFA 115-21 MCG INHALER115-21MCGHFA AER AD121212100.00000Replenished 1002015325 3085493191
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000791361 MR002109290210/20/202210/20/202210/20/202200173071620ADVAIR HFA 115-21 MCG INHALER115-21MCGHFA AER AD121212100.00000Replenished 1002076632 3098638591
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000791361 MR002109290311/17/202211/17/202211/17/202200173071620ADVAIR HFA 115-21 MCG INHALER115-21MCGHFA AER AD121212100.00000Replenished 1002137601 3113250051