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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 000000777868 MR000050780403/24/202103/24/202103/25/202100527328346LEVOTHYROXINE 88 MCG TABLET88 MCGTABLET903030100.00000Replenished 1001839075 3052306186
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795651 MR001613010405/22/202305/22/202305/23/202300527328346LEVOTHYROXINE 88 MCG TABLET88 MCGTABLET903030100.00000Replenished06/05/2023 1002226246 3135522746
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777868 MR000050780302/22/202102/22/202102/23/202100527328346LEVOTHYROXINE 88 MCG TABLET88 MCGTABLET903030100.00000Replenished 1001823796 3049396293
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778384 MR000860360303/02/202103/02/202103/03/202100527328346LEVOTHYROXINE 88 MCG TABLET88 MCGTABLET903030100.00000Replenished 1001823796 3049396293
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782206 MR003691350302/14/202202/14/202202/16/202200527328346LEVOTHYROXINE 88 MCG TABLET88 MCGTABLET90903033.33300Replenished 1002006990 3083681811
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782206 MR003691350302/14/202202/14/202202/16/202200527328346LEVOTHYROXINE 88 MCG TABLET88 MCGTABLET90906066.66700Replenished 1002011074 3084743907
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788007 MR000790050311/02/202211/02/202211/05/202200527328346LEVOTHYROXINE 88 MCG TABLET88 MCGTABLET90903033.33300Replenished 1002129142 3111671677
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788007 MR000790050311/02/202211/02/202211/05/202200527328346LEVOTHYROXINE 88 MCG TABLET88 MCGTABLET90906066.66700Replenished 1002136666 3112767814
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791709 MR000050780305/01/202305/01/202305/04/202300527328346LEVOTHYROXINE 88 MCG TABLET88 MCGTABLET90903033.33300Replenished05/18/2023 1002221191 3133750055
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791709 MR000050780305/01/202305/01/202305/04/202300527328346LEVOTHYROXINE 88 MCG TABLET88 MCGTABLET90906066.66700Replenished05/08/2023 1002213418 3132524753