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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 000000776864 MR003686600704/08/202104/08/202104/09/202155111029398SUMATRIPTAN SUCC 100 MG TABLET100 MGTABLET2799100.00000Replenished 1001860456 3056066373
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776864 MR003686600804/26/202104/26/202104/27/202155111029398SUMATRIPTAN SUCC 100 MG TABLET100 MGTABLET2799100.00000Replenished 1001860456 3056066373
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776864 MR003686600905/17/202105/17/202105/18/202155111029398SUMATRIPTAN SUCC 100 MG TABLET100 MGTABLET2799100.00000Replenished 1001860456 3056066373
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776864 MR003686601006/15/202106/15/202106/16/202155111029398SUMATRIPTAN SUCC 100 MG TABLET100 MGTABLET2799100.00000Replenished 1001897770 3062993331
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776864 MR003686601107/02/202107/02/202107/03/202155111029398SUMATRIPTAN SUCC 100 MG TABLET100 MGTABLET2799100.00000Replenished 1001897770 3062993331
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783632 MR003686600007/28/202107/28/202107/29/202155111029398SUMATRIPTAN SUCC 100 MG TABLET100 MGTABLET2799100.00000Replenished 1001897770 3062993331
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784305 MR003686600008/25/202108/25/202108/26/202155111029398SUMATRIPTAN SUCC 100 MG TABLET100 MGTABLET2799100.00000Replenished 1001951026 3072312986
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785430 MR003686600010/11/202110/11/202110/12/202155111029398SUMATRIPTAN SUCC 100 MG TABLET100 MGTABLET2799100.00000Replenished 1001951026 3072312986
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785853 MR003686600010/28/202110/28/202110/29/202155111029398SUMATRIPTAN SUCC 100 MG TABLET100 MGTABLET2799100.00000Replenished 1001951026 3072312986
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786267 MR003686600011/16/202111/16/202111/17/202155111029398SUMATRIPTAN SUCC 100 MG TABLET100 MGTABLET2799100.00000Replenished 1001994779 3081424825