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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 000000782120 B4W7RVK47LXQ0005/21/202105/21/202105/21/202100378647099SCOPOLAMINE 1 MG/3 DAY PATCH1 MG/3 DAYPATCH TD 345120.00000Replenished 1001891615 3062304712
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000782120 B4W7RVK47LXQ0005/21/202105/21/202105/21/202100378647099SCOPOLAMINE 1 MG/3 DAY PATCH1 MG/3 DAYPATCH TD 345480.00000Replenished 1001862702 3056474257
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783445 MR002255710007/20/202107/20/202107/21/202100378647099SCOPOLAMINE 1 MG/3 DAY PATCH1 MG/3 DAYPATCH TD 344125.00000Replenished 1001977132 3077860917
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783445 MR002255710007/20/202107/20/202107/21/202100378647099SCOPOLAMINE 1 MG/3 DAY PATCH1 MG/3 DAYPATCH TD 344375.00000Replenished 1001891615 3062304712
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787079 MR003085400012/21/202112/21/202112/22/202100378647099SCOPOLAMINE 1 MG/3 DAY PATCH1 MG/3 DAYPATCH TD 344375.00000Replenished 1001977132 3077860917
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794749 MR001881110012/13/202212/13/202212/15/202200378647099SCOPOLAMINE 1 MG/3 DAY PATCH1 MG/3 DAYPATCH TD 3444100.00000Replenished 1002150356 3116568459