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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 000000772437 MR000952171103/08/202103/08/202103/09/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001824202 3049524740
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780909 MR000952171102/21/202202/21/202202/22/202259746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1001515100.00000Replenished 1002027177 3088118830
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000772437 MR000952171001/27/202101/27/202101/28/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780909 MR000952171001/27/202201/27/202201/28/202259746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1001515100.00000Replenished 1002027177 3088118830
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000772437 MR000952170912/28/202012/28/202012/29/202059746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780909 MR000952170901/13/202201/13/202201/14/202259746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1001515100.00000Replenished 1001994779 3081424825
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780909 MR000952170812/07/202112/07/202112/08/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001994779 3081424825
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780909 MR000952170711/04/202111/04/202111/05/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001960301 3074163363
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780909 MR000952170610/07/202110/07/202110/08/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET100301550.00000Replenished 1001937905 3070173196
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780909 MR000952170610/07/202110/07/202110/08/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET100301550.00000Replenished 1001960301 3074163363