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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 000000775715 MR002051740106/17/202106/17/202106/18/202159746012106MECLIZINE 25 MG TABLET25 MGTABLET1006060100.00000Replenished 1002004973 3083258060
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779495 MR000050780001/27/202101/27/202101/28/202159746012106MECLIZINE 25 MG TABLET25 MGTABLET100301033.33300Replenished 1001802698
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779495 MR000050780001/27/202101/27/202101/28/202159746012106MECLIZINE 25 MG TABLET25 MGTABLET100302066.66700Replenished 1001853845 3055068759
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780216 MR003781360002/27/202102/27/202102/28/202159746012106MECLIZINE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001853845 3055068759
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781002 MR002187830004/05/202104/05/202104/07/202159746012106MECLIZINE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001853845 3055068759
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781688 MR002932520005/05/202105/05/202105/06/202159746012106MECLIZINE 25 MG TABLET25 MGTABLET100301033.33300Replenished 1001864958 3056990723
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781688 MR002932520005/05/202105/05/202105/06/202159746012106MECLIZINE 25 MG TABLET25 MGTABLET100302066.66700Replenished 1001853845 3055068759
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782227 MR003892430005/26/202105/26/202105/27/202159746012106MECLIZINE 25 MG TABLET25 MGTABLET1009090100.00000Replenished 1001864958 3056990723
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785525 MR001455130010/14/202110/14/202110/15/202159746012106MECLIZINE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1002004973 3083258060
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787907 MR002900150001/26/202201/26/202201/27/202259746012106MECLIZINE 25 MG TABLET25 MGTABLET100201050.00000Replenished 1002004973 3083258060