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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 000000777663 MR003890110103/26/202103/29/202103/30/202133342005410PIOGLITAZONE HCL 15 MG TABLET15 MGTABLET909090100.00000Replenished 1001834470 3051403572
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777663 MR003890110206/17/202106/17/202106/18/202133342005410PIOGLITAZONE HCL 15 MG TABLET15 MGTABLET90903033.33300Replenished 1001883113 3060162693
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777663 MR003890110206/17/202106/17/202106/18/202133342005410PIOGLITAZONE HCL 15 MG TABLET15 MGTABLET90906066.66700Replenished 1001876050 3059092759
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777663 MR003890110309/18/202109/18/202109/19/202133342005410PIOGLITAZONE HCL 15 MG TABLET15 MGTABLET90903033.33300Replenished 1001928804 3069023028
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777663 MR003890110309/18/202109/18/202109/19/202133342005410PIOGLITAZONE HCL 15 MG TABLET15 MGTABLET90906066.66700Replenished 1001924730 3068049382
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780828 MR003261530003/29/202103/29/202103/30/202133342005410PIOGLITAZONE HCL 15 MG TABLET15 MGTABLET909090100.00000Replenished 1001834470 3051403572
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780828 MR003261530106/29/202106/29/202106/30/202133342005410PIOGLITAZONE HCL 15 MG TABLET15 MGTABLET90903033.33300Replenished 1001924730 3068049382
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780828 MR003261530106/29/202106/29/202106/30/202133342005410PIOGLITAZONE HCL 15 MG TABLET15 MGTABLET90906066.66700Replenished 1001883113 3060162693
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781791 MR001954630005/10/202105/10/202105/11/202133342005410PIOGLITAZONE HCL 15 MG TABLET15 MGTABLET903030100.00000Replenished 1001876050 3059092759
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785081 MR003261530009/27/202109/27/202109/28/202133342005410PIOGLITAZONE HCL 15 MG TABLET15 MGTABLET90903033.33300Replenished 1001965091 3075301281