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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 000000779560 MR001221560002/01/202102/01/202102/02/202165862050320AMOX-CLAV 875-125 MG TABLET875-125 MGTABLET2014321.42900Replenished 1001824202 3049524740
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779560 MR001221560002/01/202102/01/202102/02/202165862050320AMOX-CLAV 875-125 MG TABLET875-125 MGTABLET20141178.57100Replenished 1001805758
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779834 MR003284060002/10/202102/10/202102/11/202165862050320AMOX-CLAV 875-125 MG TABLET875-125 MGTABLET201414100.00000Replenished 1001824202 3049524740
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780397 MR001082900003/09/202103/09/202103/10/202165862050320AMOX-CLAV 875-125 MG TABLET875-125 MGTABLET2020315.00000Replenished 1001824202 3049524740
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780397 MR001082900003/09/202103/09/202103/10/202165862050320AMOX-CLAV 875-125 MG TABLET875-125 MGTABLET20201785.00000Replenished 1001824882 3049647435
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780455 MR003737670003/10/202103/10/202103/11/202165862050320AMOX-CLAV 875-125 MG TABLET875-125 MGTABLET2014321.42900Replenished 1001824882 3049647435
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780455 MR003737670003/10/202103/10/202103/11/202165862050320AMOX-CLAV 875-125 MG TABLET875-125 MGTABLET20141178.57100Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780717 MR001776150003/23/202103/23/202103/25/202165862050320AMOX-CLAV 875-125 MG TABLET875-125 MGTABLET2010110.00000Replenished 1001832780 3051158401
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780717 MR001776150003/23/202103/23/202103/25/202165862050320AMOX-CLAV 875-125 MG TABLET875-125 MGTABLET2010990.00000Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780758 BRHXYP9KVQPX0003/25/202103/25/202103/26/202165862050320AMOX-CLAV 875-125 MG TABLET875-125 MGTABLET202015.00000Replenished 1001835626 3051655272