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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 000000773542 MR001709231005/07/202105/07/202105/08/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1006023.33300Replenished 1001856282 3055381317
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774929 MR001709230006/01/202106/01/202106/02/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR10018021.11100Replenished 1001871163 3057980095
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776705 MR002521900502/24/202102/24/202102/25/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1003026.66700Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778884 MR002341130103/31/202103/31/202104/01/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR10018021.11100Replenished 1001839075 3052306186
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779707 MR002239180002/05/202102/05/202102/06/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1009022.22300Replenished 1001816056 987916714
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780544 MR001786960205/27/202105/27/202105/28/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1003026.66700Replenished 1001867724 3057523425
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780873 MR002221140003/30/202103/30/202103/31/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1009022.22200Replenished 1001835626 3051655272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780901 MR000272440104/27/202104/27/202104/28/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1006023.33300Replenished 1001850989 3054468652
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789247 MR001786960308/30/202208/30/202209/01/202268462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1003026.66700Replenished 1002099459 3104747366
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789711 MR003865030107/20/202207/20/202207/22/202268462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1009022.22200Replenished 1002082636 3100356570