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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 000000778093 MR000530370011/25/202011/25/202011/26/202050111078751AZITHROMYCIN 250 MG TABLET250 MGTABLET66583.33300Replenished 1001776446
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782691 MR002239180006/15/202106/15/202106/16/202150111078751AZITHROMYCIN 250 MG TABLET250 MGTABLET666100.00000Replenished 1001877828 3059333148
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782857 MR000395960006/23/202106/23/202106/24/202150111078751AZITHROMYCIN 250 MG TABLET250 MGTABLET666100.00000Replenished 1001879330 3059650533
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782864 MR000050780006/24/202106/24/202106/25/202150111078751AZITHROMYCIN 250 MG TABLET250 MGTABLET666100.00000Replenished 1001880371 3059776595
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783453 BUE7D3FB4PPE0007/20/202107/20/202107/21/202150111078751AZITHROMYCIN 250 MG TABLET250 MGTABLET666100.00000Replenished 1001891615 3062304712
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784515 MR003905540009/02/202109/02/202109/03/202150111078751AZITHROMYCIN 250 MG TABLET250 MGTABLET666100.00000Replenished 1001917809 3066693686
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784577 BXADJGG2224U0009/07/202109/07/202109/08/202150111078751AZITHROMYCIN 250 MG TABLET250 MGTABLET622100.00000Replenished 1001929791 3069291945
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785173 MR002281310009/29/202109/29/202109/30/202150111078751AZITHROMYCIN 250 MG TABLET250 MGTABLET66233.33300Replenished 1001937905 3070173196
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785173 MR002281310009/29/202109/29/202109/30/202150111078751AZITHROMYCIN 250 MG TABLET250 MGTABLET66466.66700Replenished 1001929791 3069291945
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785344 MR003928040010/07/202110/07/202110/08/202150111078751AZITHROMYCIN 250 MG TABLET250 MGTABLET66233.33300Replenished 1001939962 3070708844