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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 000000777278 MR000415970010/21/202010/21/202010/22/202062175026137NIFEDIPINE ER 60 MG TABLET60 MGTAB ER2 24100602033.33300Replenished 1001843344 3052979164
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777278 MR000415970010/21/202010/21/202010/22/202062175026137NIFEDIPINE ER 60 MG TABLET60 MGTAB ER2 24100604066.66700Replenished 1001753044
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778819 MR000415970012/28/202012/28/202012/29/202062175026137NIFEDIPINE ER 60 MG TABLET60 MGTAB ER2 24100602033.33300Replenished 1001843344 3052979164
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778819 MR000415970012/28/202012/28/202012/29/202062175026137NIFEDIPINE ER 60 MG TABLET60 MGTAB ER2 24100604066.66700Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779840 MR000415970002/11/202102/11/202102/12/202162175026137NIFEDIPINE ER 60 MG TABLET60 MGTAB ER2 241006060100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779840 MR000415970104/14/202104/14/202104/15/202162175026137NIFEDIPINE ER 60 MG TABLET60 MGTAB ER2 241006060100.00000Replenished 1001843344 3052979164
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779840 MR000415970206/09/202106/09/202106/10/202162175026137NIFEDIPINE ER 60 MG TABLET60 MGTAB ER2 241006060100.00000Replenished 1001872170 3058237732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779840 MR000415970308/18/202108/18/202108/19/202162175026137NIFEDIPINE ER 60 MG TABLET60 MGTAB ER2 24100601016.66700Replenished 1001872170 3058237732
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779840 MR000415970308/18/202108/18/202108/19/202162175026137NIFEDIPINE ER 60 MG TABLET60 MGTAB ER2 24100605083.33300Replenished 1001945703 3071287759
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782550 MR001542460006/09/202106/09/202106/10/202162175026137NIFEDIPINE ER 60 MG TABLET60 MGTAB ER2 241003030100.00000Replenished 1001872170 3058237732