Back

Accumulator - View By Claim

Export to Excel

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 000000785591 MR003691350010/18/202110/18/202110/19/202155111025660ZIPRASIDONE HCL 20 MG CAPSULE20 MGCAPSULE606060100.00000Replenished 1001945251 3071148263
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786252 MR003691350011/16/202111/16/202111/17/202155111025660ZIPRASIDONE HCL 20 MG CAPSULE20 MGCAPSULE606060100.00000Replenished 1001960301 3074163363
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787064 MR003691350012/20/202112/20/202112/21/202155111025660ZIPRASIDONE HCL 20 MG CAPSULE20 MGCAPSULE606060100.00000Replenished 1001976721 3077692823
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787712 MR003691350001/18/202201/18/202201/19/202255111025660ZIPRASIDONE HCL 20 MG CAPSULE20 MGCAPSULE606060100.00000Replenished 1001990723 3080663331
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788264 MR003691350002/14/202202/14/202202/16/202255111025660ZIPRASIDONE HCL 20 MG CAPSULE20 MGCAPSULE606060100.00000Replenished 1002006990 3083681811
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789116 MR003691350003/22/202203/22/202203/23/202255111025660ZIPRASIDONE HCL 20 MG CAPSULE20 MGCAPSULE606060100.00000Replenished 1002024556 3087532840