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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 000000774459 MR002183130304/07/202104/07/202104/08/202165162010110GABAPENTIN 100 MG CAPSULE100 MGCAPSULE100270155.55600Replenished 1001839075 3052306186
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774459 MR002183130304/07/202104/07/202104/08/202165162010110GABAPENTIN 100 MG CAPSULE100 MGCAPSULE1002705520.37000Replenished 1001842172 3052723058
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774459 MR002183130304/07/202104/07/202104/08/202165162010110GABAPENTIN 100 MG CAPSULE100 MGCAPSULE10027010037.03700Replenished 1001839075 3052306186
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774459 MR002183130304/07/202104/07/202104/08/202165162010110GABAPENTIN 100 MG CAPSULE100 MGCAPSULE10027010037.03700Replenished 1001839075 3052306186
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774565 MR002341130203/01/202103/01/202103/02/202165162010110GABAPENTIN 100 MG CAPSULE100 MGCAPSULE1003607520.83300Replenished 1001825446 3049810902
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774565 MR002341130203/01/202103/01/202103/02/202165162010110GABAPENTIN 100 MG CAPSULE100 MGCAPSULE1003608523.61100Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774565 MR002341130203/01/202103/01/202103/02/202165162010110GABAPENTIN 100 MG CAPSULE100 MGCAPSULE10036010027.77800Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774565 MR002341130203/01/202103/01/202103/02/202165162010110GABAPENTIN 100 MG CAPSULE100 MGCAPSULE10036010027.77800Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774658 MR000220060206/17/202106/17/202106/18/202165162010110GABAPENTIN 100 MG CAPSULE100 MGCAPSULE1001808547.22200Replenished 1001877828 3059333148
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774658 MR000220060206/17/202106/17/202106/18/202165162010110GABAPENTIN 100 MG CAPSULE100 MGCAPSULE1001809552.77800Replenished 1001876050 3059092759