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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 000000779950 MR001406320002/16/202102/16/202102/17/202116729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET1001515100.00000Replenished 1001818667 988063364
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780080 MR000247430002/22/202102/22/202102/23/202116729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET1003030100.00000Replenished 1001818667 988063364
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780195 22401450002/26/202102/26/202102/28/202116729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET100901112.22200Replenished 1001818667 988063364
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780195 22401450002/26/202102/26/202102/28/202116729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET100907987.77800Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780230 22413400003/01/202103/01/202103/02/202116729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET100902123.33300Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780230 22413400003/01/202103/01/202103/02/202116729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET100906976.66700Replenished 1001822140 3049139687
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780560 MR002647520003/15/202103/15/202103/16/202116729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET1004545100.00000Replenished 1001827193 3050193216
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780580 MR001024640003/16/202103/16/202103/17/202116729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET100903640.00000Replenished 1001827193 3050193216
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780580 MR001024640003/16/202103/16/202103/17/202116729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET100905460.00000Replenished 1001834470 3051403572
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780680 MR001746970003/22/202103/22/202103/23/202116729018301HYDROCHLOROTHIAZIDE 25 MG TAB25 MGTABLET1001515100.00000Replenished 1001834470 3051403572