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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 000000780516 MR000378510003/12/202103/12/202103/13/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100903033.33300Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780516 MR000378510003/12/202103/12/202103/13/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100906066.66700Replenished 1001825961 3049810904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781669 MR000378510005/04/202105/04/202105/05/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100901011.11100Replenished 1001858827 3055792360
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781669 MR000378510005/04/202105/04/202105/05/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100908088.88900Replenished 1001852121 3054859692
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781669 MR000378510106/18/202106/18/202106/19/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100901011.11100Replenished 1001876579 3059092930
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781669 MR000378510106/18/202106/18/202106/19/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100908088.88900Replenished 1001877828 3059333148
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783928 MR000378510008/10/202108/10/202108/11/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100902022.22200Replenished 1001904997 3064847322
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783928 MR000378510008/10/202108/10/202108/11/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100907077.77800Replenished 1001922312 3067326646
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783928 MR000378510110/19/202110/19/202110/20/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET1009055.55600Replenished 1001945703 3071287759
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783928 MR000378510110/19/202110/19/202110/20/202142806016001HYDROXYZINE HCL 25 MG TABLET25 MGTABLET100908594.44400Replenished 1001952043 3072719019