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 000000779813 MR000684920002/10/202102/10/202102/11/202100527328646LEVOTHYROXINE 125 MCG TABLET125 MCGTABLET909090100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777996 MR003261530001/18/202101/18/202101/19/202100527328646LEVOTHYROXINE 125 MCG TABLET125 MCGTABLET90908088.88900Replenished 1001798519
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779813 MR000684920105/14/202105/14/202105/15/202100527328646LEVOTHYROXINE 125 MCG TABLET125 MCGTABLET90908088.88900Replenished 1001859387 3055792361
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783916 MR002263910112/09/202112/09/202112/11/202100527328646LEVOTHYROXINE 125 MCG TABLET125 MCGTABLET90908088.88900Replenished 1001972080 3076588674
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786215 MR000684920011/12/202111/12/202111/13/202100527328646LEVOTHYROXINE 125 MCG TABLET125 MCGTABLET90908088.88900Replenished 1001958724 3073746995
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787360 MR003261530001/03/202201/03/202201/04/202200527328646LEVOTHYROXINE 125 MCG TABLET125 MCGTABLET90908088.88900Replenished 1002043399 3091212807
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789770 MR002598600006/03/202206/03/202206/04/202200527328646LEVOTHYROXINE 125 MCG TABLET125 MCGTABLET90908088.88900Replenished 1002062399 3095062965
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792512 MR002598600008/29/202208/29/202208/30/202200527328646LEVOTHYROXINE 125 MCG TABLET125 MCGTABLET90908088.88900Replenished 1002099121 3104604852
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781282 MR003261530004/19/202104/19/202104/20/202100527328646LEVOTHYROXINE 125 MCG TABLET125 MCGTABLET90907077.77800Replenished 1001848263 3053810034
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783916 MR002263910008/09/202108/09/202108/11/202100527328646LEVOTHYROXINE 125 MCG TABLET125 MCGTABLET90907077.77800Replenished 1001903117 3064415063