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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 000000780234 MR002341130003/01/202103/01/202103/02/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET10027010037.03700Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780234 MR002341130003/01/202103/01/202103/02/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET10027010037.03700Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780234 MR002341130106/01/202106/01/202106/02/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET10027010037.03700Replenished 1001867724 3057523425
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780234 MR002341130106/01/202106/01/202106/02/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET10027010037.03700Replenished 1001867724 3057523425
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780234 MR002341130209/04/202109/04/202109/05/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET10027010037.03700Replenished 1001918470 3066738110
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780234 MR002341130312/03/202112/03/202112/04/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET10027010037.03700Replenished 1001966593 3075785867
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780234 MR002341130312/03/202112/03/202112/04/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET10027010037.03700Replenished 1001966593 3075785867
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780234 MR002341130209/04/202109/04/202109/05/202162332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET1002709535.18500Replenished 1001918470 3066738110
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788687 MR002341130105/02/202205/02/202205/03/202262332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET1009090100.00000Replenished 1002045985 3091824990
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788687 MR002341130408/24/202208/24/202208/25/202262332003231ROPINIROLE HCL 1 MG TABLET1 MGTABLET1009090100.00000Replenished 1002100079 3104971541