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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 000000776323 MR002603411109/09/202109/09/202109/10/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET9030310.00000Replenished 1001923041 3067590209
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777779 MR001652240605/10/202105/10/202105/11/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET9030310.00000Replenished 1001856282 3055381317
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779602 MR003922451412/29/202112/29/202112/30/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET9021314.28600Replenished 1001982259 3078646785
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781743 MR000374450005/06/202105/06/202105/07/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET9030310.00000Replenished 1001854421 3055134799
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784716 MR000620750009/13/202109/13/202109/14/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET909033.33300Replenished 1001929791 3069291945
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776323 MR002603410402/04/202102/04/202102/06/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET9030620.00000Replenished 1001807887
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776536 MR001943700502/19/202102/19/202102/20/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET9030620.00000Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777779 MR001652240403/09/202103/09/202103/10/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET9030620.00000Replenished 1001824202 3049524740
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781141 MR002044000004/12/202104/12/202104/13/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET9030620.00000Replenished 1001854421 3055134799
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783602 MR001943700209/29/202109/29/202109/30/202100527328546LEVOTHYROXINE 112 MCG TABLET112 MCGTABLET9030620.00000Replenished 1001929791 3069291945