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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 000000784494 MR003691350009/02/202109/02/202109/03/202143598016430OLANZAPINE 5 MG TABLET5 MGTABLET303030100.00000Replenished 1001917809 3066693686
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794220 MR000149560011/14/202211/14/202211/15/202243598016430OLANZAPINE 5 MG TABLET5 MGTABLET303030100.00000Replenished 1002136666 3112767814
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794812 MR000149560012/13/202212/13/202212/15/202243598016430OLANZAPINE 5 MG TABLET5 MGTABLET303030100.00000Replenished 1002150356 3116568459
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795443 MR000149560001/12/202301/12/202301/13/202343598016430OLANZAPINE 5 MG TABLET5 MGTABLET303030100.00000Replenished 1002163795 3119751774
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795925 MR000149560002/06/202302/06/202302/11/202343598016430OLANZAPINE 5 MG TABLET5 MGTABLET303030100.00000Replenished 1002178117 3123055057
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795925 MR000149560103/02/202303/02/202303/03/202343598016430OLANZAPINE 5 MG TABLET5 MGTABLET303030100.00000Replenished 1002184466 3125496601
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795925 MR000149560204/05/202304/05/202304/06/202343598016430OLANZAPINE 5 MG TABLET5 MGTABLET303030100.00000Replenished 1002199093 3129254774