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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 000000774615 MR001715220303/31/202103/31/202104/01/202100173071920FLOVENT HFA 110 MCG INHALER110 MCGAER W/ADAP121212100.00000Replenished 1001835626 3051655272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775660 MR001483000906/09/202106/09/202107/01/202100173071920FLOVENT HFA 110 MCG INHALER110 MCGAER W/ADAP121212100.00000Replenished 1001884259 3060456965
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781628 MR001715220005/03/202105/03/202105/04/202100173071920FLOVENT HFA 110 MCG INHALER110 MCGAER W/ADAP121212100.00000Replenished 1001851763 3054766187
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783414 MR001483000007/19/202107/19/202108/13/202100173071920FLOVENT HFA 110 MCG INHALER110 MCGAER W/ADAP12361233.33300Replenished 1001903802 3064589183
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783414 MR001483000007/19/202107/19/202108/13/202100173071920FLOVENT HFA 110 MCG INHALER110 MCGAER W/ADAP12361233.33300Replenished 1001903802 3064589183
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783414 MR001483000007/19/202107/19/202108/13/202100173071920FLOVENT HFA 110 MCG INHALER110 MCGAER W/ADAP12361233.33400Replenished 1001903802 3064589183
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783414 MR001483000110/25/202110/25/202110/27/202100173071920FLOVENT HFA 110 MCG INHALER110 MCGAER W/ADAP12361233.33300Replenished 1001948857 3071997279
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783414 MR001483000110/25/202110/25/202110/27/202100173071920FLOVENT HFA 110 MCG INHALER110 MCGAER W/ADAP12361233.33300Replenished 1001948857 3071997279
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783414 MR001483000110/25/202110/25/202110/27/202100173071920FLOVENT HFA 110 MCG INHALER110 MCGAER W/ADAP12361233.33400Replenished 1001948857 3071997279
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783414 MR001483000201/31/202201/31/202202/02/202200173071920FLOVENT HFA 110 MCG INHALER110 MCGAER W/ADAP12361233.33300Replenished 1001998721 3082187336