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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 000000780855 MR003466920003/29/202103/29/202103/30/202100378632477VALSARTAN-HCTZ 320-12.5 MG TAB320-12.5MGTABLET909090100.00000Replenished 1001834470 3051403572
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782781 MR003466920006/21/202106/21/202106/22/202100378632477VALSARTAN-HCTZ 320-12.5 MG TAB320-12.5MGTABLET909090100.00000Replenished 1001877828 3059333148
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785113 MR003466920009/28/202109/28/202109/29/202100378632477VALSARTAN-HCTZ 320-12.5 MG TAB320-12.5MGTABLET909090100.00000Replenished 1001929356 3069158825
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793604 MR003466920101/18/202301/18/202301/19/202300378632477VALSARTAN-HCTZ 320-12.5 MG TAB320-12.5MGTABLET909090100.00000Replenished 1002165418 3120576240
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793604 MR003466920203/27/202303/27/202303/28/202300378632477VALSARTAN-HCTZ 320-12.5 MG TAB320-12.5MGTABLET909090100.00000Replenished 1002195747 3128183260
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000799349 MR003466920007/25/202307/25/202307/26/202300378632477VALSARTAN-HCTZ 320-12.5 MG TAB320-12.5MGTABLET909090100.00000Replenished08/22/2023 1002250897 3141314504