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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)Cash 340B 000000781610 6004266990005/03/202105/03/202105/03/202151672400501CARBAMAZEPINE 200 MG TABLET200 MGTABLET1001202016.66700Replenished 1001851763 3054766187
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000781610 6004266990005/03/202105/03/202105/03/202151672400501CARBAMAZEPINE 200 MG TABLET200 MGTABLET10012010083.33300Replenished 1001851763 3054766187
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Cash 340B 000000782928 6004266990006/28/202106/28/202106/28/202151672400501CARBAMAZEPINE 200 MG TABLET200 MGTABLET10012010083.33300Replenished 1001851763 3054766187
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780547 6004266990003/15/202103/15/202103/16/202151672400501CARBAMAZEPINE 200 MG TABLET200 MGTABLET1001208066.66700Replenished 1001851763 3054766187
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779204 6004266990001/14/202101/14/202101/15/202151672400501CARBAMAZEPINE 200 MG TABLET200 MGTABLET1001206050.00000Replenished 1001826768 3050065356
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780547 6004266990003/15/202103/15/202103/16/202151672400501CARBAMAZEPINE 200 MG TABLET200 MGTABLET1001204033.33300Replenished 1001826768 3050065356
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779204 6004266990001/14/202101/14/202101/15/202151672400501CARBAMAZEPINE 200 MG TABLET200 MGTABLET1001206050.00000Replenished 1001796904