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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 000000777652 MR000130120302/12/202102/12/202102/13/202169584009210BUSPIRONE HCL 10 MG TABLET10 MGTABLET1006060100.00000Replenished 1001825446 3049810902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777652 MR000130120403/11/202103/11/202103/12/202169584009210BUSPIRONE HCL 10 MG TABLET10 MGTABLET100602033.33300Replenished 1001825446 3049810902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777652 MR000130120403/11/202103/11/202103/12/202169584009210BUSPIRONE HCL 10 MG TABLET10 MGTABLET100604066.66700Replenished 1001860040 3055907871
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777815 MR001540790201/13/202101/13/202101/14/202169584009210BUSPIRONE HCL 10 MG TABLET10 MGTABLET1001802011.11100Replenished 1001825446 3049810902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777815 MR001540790201/13/202101/13/202101/14/202169584009210BUSPIRONE HCL 10 MG TABLET10 MGTABLET1001806033.33300Replenished 1001796406
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777815 MR001540790201/13/202101/13/202101/14/202169584009210BUSPIRONE HCL 10 MG TABLET10 MGTABLET10018010055.55600Replenished 1001796406
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781606 MR003895020004/30/202104/30/202105/01/202169584009210BUSPIRONE HCL 10 MG TABLET10 MGTABLET1006060100.00000Replenished 1001860040 3055907871