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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 000000777618 MR001511490403/04/202103/04/202103/05/202116729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET1003013.33300Replenished 1001822140 3049139687
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780837 MR001797270003/29/202103/29/202103/30/202116729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET1003013.33300Replenished 1001834470 3051403572
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781200 MR002647520006/03/202106/03/202106/04/202116729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET1004512.22200Replenished 1001868899 3057728019
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782750 MR001511490605/03/202205/03/202205/04/202216729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET1003013.33300Replenished 1002045985 3091824990
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783967 MR002793580311/01/202111/01/202111/02/202116729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET1003013.33300Replenished 1001951777 3072578295
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791430 MR000711870007/11/202207/11/202207/12/202216729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET1009011.11100Replenished 1002078923 3099104399
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792448 MR001624700111/15/202211/15/202211/16/202216729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET1009011.11100Replenished 1002136934 3112920976
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777618 MR001511490706/03/202106/03/202106/18/202116729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET10030413.33300Replenished 1001889580 3061517655
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780080 MR000247430608/13/202108/13/202108/14/202116729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET10030413.33300Replenished 1001915815 3066004377
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781592 MR001179140303/04/202203/04/202203/05/202216729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET1009044.44400Replenished 1002024556 3087532840