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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 000000771674 109900301/28/202101/28/202101/29/202150228010701METFORMIN HCL 1,000 MG TABLET1000 MGTABLET10018052.77800Replenished 1001803460
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000771674 109900301/28/202101/28/202101/29/202150228010701METFORMIN HCL 1,000 MG TABLET1000 MGTABLET1001807541.66700Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000771674 109900301/28/202101/28/202101/29/202150228010701METFORMIN HCL 1,000 MG TABLET1000 MGTABLET10018010055.55500Replenished 1001803460
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776322 MR002603410502/09/202102/09/202102/10/202150228010701METFORMIN HCL 1,000 MG TABLET1000 MGTABLET1006060100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776322 MR002603410603/16/202103/16/202103/17/202150228010701METFORMIN HCL 1,000 MG TABLET1000 MGTABLET100602541.66700Replenished 1001827193 3050193216
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776322 MR002603410603/16/202103/16/202103/17/202150228010701METFORMIN HCL 1,000 MG TABLET1000 MGTABLET100603558.33300Replenished 1001828208 3050330142
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778081 MR002793580103/17/202103/17/202103/18/202150228010701METFORMIN HCL 1,000 MG TABLET1000 MGTABLET1001806536.11100Replenished 1001828208 3050330142
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778081 MR002793580103/17/202103/17/202103/18/202150228010701METFORMIN HCL 1,000 MG TABLET1000 MGTABLET10018010055.55600Replenished 1001828208 3050330142
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778414 MR002967620202/18/202102/18/202102/19/202150228010701METFORMIN HCL 1,000 MG TABLET1000 MGTABLET1006058.33300Replenished 1001814475 987756775
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778414 MR002967620202/18/202102/18/202102/19/202150228010701METFORMIN HCL 1,000 MG TABLET1000 MGTABLET100605591.66700Replenished 1001819785 3048855808