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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 000000785499 MR000171950111/10/202111/10/202111/11/202165862046890LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET903030100.00000Replenished 1001976721 3077692823
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785499 MR000171950212/10/202112/10/202112/11/202165862046890LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET903030100.00000Replenished 1001976721 3077692823
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785499 MR000171950301/05/202201/05/202201/06/202265862046890LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET903030100.00000Replenished 1001985204 3079284650
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785918 MR002771770011/01/202111/01/202111/02/202165862046890LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET909090100.00000Replenished 1001951777 3072578295
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786919 MR002684010012/14/202112/14/202112/15/202165862046890LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET90903033.33300Replenished 1001976721 3077692823
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786919 MR002684010012/14/202112/14/202112/15/202165862046890LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET90906066.66700Replenished 1001985204 3079284650
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786919 MR002684010103/14/202203/14/202203/16/202265862046890LOSARTAN-HCTZ 50-12.5 MG TAB50-12.5 MGTABLET909090100.00000Replenished 1002019477 3086660576