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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 000000778129 MR000272440201/26/202101/26/202101/27/202168001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H100301033.33300Replenished 1001802067
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778129 MR000272440201/26/202101/26/202101/27/202168001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H100302066.66700Replenished 1001832780 3051158401
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778129 MR000272440303/01/202103/01/202103/02/202168001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H1003030100.00000Replenished 1001832780 3051158401
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778529 MR002937890202/15/202102/15/202102/16/202168001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H1003030100.00000Replenished 1001832780 3051158401
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778529 MR002937890303/16/202103/16/202103/17/202168001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H100301033.33300Replenished 1001835626 3051655272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778529 MR002937890303/16/202103/16/202103/17/202168001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H100302066.66700Replenished 1001832780 3051158401
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780902 MR000272440003/31/202103/31/202104/01/202168001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H1003030100.00000Replenished 1001835626 3051655272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780902 MR000272440104/27/202104/27/202104/28/202168001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H1003030100.00000Replenished 1001849752 3054181639
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780902 MR000272440205/27/202105/27/202105/28/202168001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H1003030100.00000Replenished 1001865893 3057164796
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780902 MR000272440306/24/202106/24/202106/25/202168001035600METOPROLOL SUCC ER 25 MG TAB25 MGTAB.SR 24H100301033.33300Replenished 1001898379 3063180504