Back

Accumulator - View By Claim

Export to Excel

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 000000779681 MR003154420608/02/202108/02/202108/03/202100527293237PREDNISONE 5 MG TABLET5 MGTABLET100301033.33300Replenished 1001963534 3074872858
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779681 MR003154420708/28/202108/28/202108/29/202100527293237PREDNISONE 5 MG TABLET5 MGTABLET1003030100.00000Replenished 1001963534 3074872858
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779681 MR003154420809/27/202109/27/202109/28/202100527293237PREDNISONE 5 MG TABLET5 MGTABLET1003030100.00000Replenished 1001963534 3074872858
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785889 MR001483000011/01/202111/01/202111/02/202100527293237PREDNISONE 5 MG TABLET5 MGTABLET1001515100.00000Replenished 1001963534 3074872858
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786431 MR001082060011/23/202111/23/202111/24/202100527293237PREDNISONE 5 MG TABLET5 MGTABLET1001515100.00000Replenished 1001963534 3074872858
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779681 MR003154420406/07/202106/07/202106/08/202100527293237PREDNISONE 5 MG TABLET5 MGTABLET100302066.66700Replenished 1001899045 3063437222
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779681 MR003154420506/28/202106/28/202106/29/202100527293237PREDNISONE 5 MG TABLET5 MGTABLET1003030100.00000Replenished 1001899045 3063437222
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779681 MR003154420608/02/202108/02/202108/03/202100527293237PREDNISONE 5 MG TABLET5 MGTABLET100302066.66700Replenished 1001899045 3063437222
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782620 4900006/16/202106/16/202106/17/202100527293237PREDNISONE 5 MG TABLET5 MGTABLET1003030100.00000Replenished 1001899045 3063437222
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777784 MR001586200204/30/202104/30/202105/01/202100527293237PREDNISONE 5 MG TABLET5 MGTABLET100903033.33300Replenished 1001871163 3057980095