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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 000000772286 MR002561370201/15/202101/15/202101/16/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET100908594.44400Replenished 1001797497
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777474 MR001741360307/28/202107/28/202107/29/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET100908594.44400Replenished 1001906178 3065115185
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785943 MR001741360011/01/202111/01/202111/02/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET100908594.44400Replenished 1001951777 3072578295
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777474 MR001741360204/30/202104/30/202105/01/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET100908088.88900Replenished 1001850989 3054468652
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782895 MR001901990006/25/202106/25/202106/26/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET100908088.88900Replenished 1001897770 3062993331
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785060 MR001901990009/27/202109/27/202109/28/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET100908088.88900Replenished 1001951777 3072578295
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780907 MR001901990003/31/202103/31/202104/01/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET100907583.33300Replenished 1001839679 3052473904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782025 MR000353890108/18/202108/18/202108/19/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET100907583.33300Replenished 1001928804 3069023028
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782025 MR000353890005/18/202105/18/202105/19/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET100906066.66700Replenished 1001860966 3056169530
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777474 MR001741360101/22/202101/22/202101/23/202100378023101ATENOLOL 50 MG TABLET50 MGTABLET100905561.11100Replenished 1001830991 3050869519