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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 000000787105 MR003893710309/22/202209/22/202209/23/202260505014200GLIPIZIDE 10 MG TABLET10 MGTABLET10018063.33300Replenished 1002110013 3107139019
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787105 MR003893710309/22/202209/22/202209/23/202260505014200GLIPIZIDE 10 MG TABLET10 MGTABLET1001807441.11100Replenished 1002151463 3116913607
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787105 MR003893710309/22/202209/22/202209/23/202260505014200GLIPIZIDE 10 MG TABLET10 MGTABLET10018010055.55600Replenished 1002110013 3107139019
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787105 MR003893710206/23/202206/23/202206/24/202260505014200GLIPIZIDE 10 MG TABLET10 MGTABLET1001808647.77800Replenished 1002073100 3097384162
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787105 MR003893710206/23/202206/23/202206/24/202260505014200GLIPIZIDE 10 MG TABLET10 MGTABLET1001809452.22200Replenished 1002110013 3107139019
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787105 MR003893710103/23/202203/23/202203/24/202260505014200GLIPIZIDE 10 MG TABLET10 MGTABLET100180147.77700Replenished 1002073100 3097384162
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787105 MR003893710103/23/202203/23/202203/24/202260505014200GLIPIZIDE 10 MG TABLET10 MGTABLET1001806636.66700Replenished 1002024556 3087532840
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787105 MR003893710103/23/202203/23/202203/24/202260505014200GLIPIZIDE 10 MG TABLET10 MGTABLET10018010055.55600Replenished 1002024556 3087532840
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794896 MR003893710103/24/202303/24/202303/25/202360505014200GLIPIZIDE 10 MG TABLET10 MGTABLET1001803418.88800Replenished06/26/2023 1002237206 3137855547
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794896 MR003893710103/24/202303/24/202303/25/202360505014200GLIPIZIDE 10 MG TABLET10 MGTABLET1001804625.55600Replenished 1002195085 3127879945