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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 000000789200 MR001624700306/27/202206/27/202206/28/202256151173101TRUEPLUS SYR 0.3ML 31GX5/16"31 GX5/16"DISP SYRIN100100100100.00000Replenished 1002074778 3097678846
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789200 MR001624700407/27/202207/27/202207/28/202256151173101TRUEPLUS SYR 0.3ML 31GX5/16"31 GX5/16"DISP SYRIN100100100100.00000Replenished 1002084916 3100895805
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789200 MR001624700508/25/202208/25/202208/26/202256151173101TRUEPLUS SYR 0.3ML 31GX5/16"31 GX5/16"DISP SYRIN100100100100.00000Replenished 1002097780 3104187394
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789200 MR001624700609/23/202209/23/202209/24/202256151173101TRUEPLUS SYR 0.3ML 31GX5/16"31 GX5/16"DISP SYRIN100100100100.00000Replenished 1002110752 3107139680
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793749 MR001624700010/24/202210/24/202210/25/202256151173101TRUEPLUS SYR 0.3ML 31GX5/16"31 GX5/16"DISP SYRIN100100100100.00000Replenished 1002125076 3110431981
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794371 MR001624700011/21/202211/21/202211/22/202256151173101TRUEPLUS SYR 0.3ML 31GX5/16"31 GX5/16"DISP SYRIN100100100100.00000Replenished 1002138660 3113575594
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794371 MR001624700112/23/202212/23/202212/24/202256151173101TRUEPLUS SYR 0.3ML 31GX5/16"31 GX5/16"DISP SYRIN100100100100.00000Replenished 1002152667 3117383033