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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 000000784403 MR002876581107/25/202207/25/202207/26/202268001033400LISINOPRIL 10 MG TABLET10 MGTABLET1003030100.00000Replenished 1002093757 3102657638
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787228 MR001198521111/18/202211/18/202211/19/202268001033400LISINOPRIL 10 MG TABLET10 MGTABLET1003030100.00000Replenished 1002138660 3113575596
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790423 MR000186701104/25/202304/25/202304/26/202368001033400LISINOPRIL 10 MG TABLET10 MGTABLET1003030100.00000Replenished05/08/2023 1002213772 3132524754
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784403 MR002876581006/24/202206/24/202206/25/202268001033400LISINOPRIL 10 MG TABLET10 MGTABLET1003030100.00000Replenished 1002073350 3097384163
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787228 MR001198521010/24/202210/24/202210/25/202268001033400LISINOPRIL 10 MG TABLET10 MGTABLET1003030100.00000Replenished 1002129142 3111671677
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790423 MR000186701003/27/202303/27/202303/28/202368001033400LISINOPRIL 10 MG TABLET10 MGTABLET1003030100.00000Replenished 1002198481 3129060211
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775867 MR002876580906/21/202106/21/202106/22/202168001033400LISINOPRIL 10 MG TABLET10 MGTABLET1003030100.00000Replenished 1001880371 3059776595
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776361 MR001513540907/10/202107/10/202107/11/202168001033400LISINOPRIL 10 MG TABLET10 MGTABLET1006060100.00000Replenished 1001889250 3061354275
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784403 MR002876580905/20/202205/20/202205/21/202268001033400LISINOPRIL 10 MG TABLET10 MGTABLET1003030100.00000Replenished 1002058743 3094409887
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787228 MR001198520909/22/202209/22/202209/23/202268001033400LISINOPRIL 10 MG TABLET10 MGTABLET1003030100.00000Replenished 1002118447 3108304458