Back

Accumulator - View By Claim

Export to Excel

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 000000785346 MR002937890010/07/202110/07/202110/08/202129300016915TIZANIDINE HCL 4 MG TABLET4 MGTABLET1503030100.00000Replenished 1001978209 3078024705
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786092 MR001613010011/08/202111/08/202111/09/202129300016915TIZANIDINE HCL 4 MG TABLET4 MGTABLET1502020100.00000Replenished 1001978209 3078024705
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786240 MR002937890011/15/202111/15/202111/16/202129300016915TIZANIDINE HCL 4 MG TABLET4 MGTABLET1503030100.00000Replenished 1001978209 3078024705
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786640 MR001613010012/01/202112/01/202112/02/202129300016915TIZANIDINE HCL 4 MG TABLET4 MGTABLET1502020100.00000Replenished 1001978209 3078024705
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787087 MR002937890012/21/202112/21/202112/22/202129300016915TIZANIDINE HCL 4 MG TABLET4 MGTABLET1503030100.00000Replenished 1001978209 3078024705
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787106 MR001613010012/22/202112/22/202112/23/202129300016915TIZANIDINE HCL 4 MG TABLET4 MGTABLET1502020100.00000Replenished 1001978209 3078024705