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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 000000780151 MR000510590003/19/202103/19/202103/20/202168001015400CARVEDILOL 6.25 MG TABLET6.25 MGTABLET1003030100.00000Replenished 1001839075 3052306186
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780151 MR000510590104/06/202104/06/202104/07/202168001015400CARVEDILOL 6.25 MG TABLET6.25 MGTABLET1003030100.00000Replenished 1001839075 3052306186
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780151 MR000510590204/29/202104/29/202104/30/202168001015400CARVEDILOL 6.25 MG TABLET6.25 MGTABLET1003030100.00000Replenished 1001871163 3057980095
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781044 MR003185700004/07/202104/07/202104/08/202168001015400CARVEDILOL 6.25 MG TABLET6.25 MGTABLET1001804022.22200Replenished 1001839075 3052306186
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781044 MR003185700004/07/202104/07/202104/08/202168001015400CARVEDILOL 6.25 MG TABLET6.25 MGTABLET1001804022.22200Replenished 1001871163 3057980095
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781044 MR003185700004/07/202104/07/202104/08/202168001015400CARVEDILOL 6.25 MG TABLET6.25 MGTABLET10018010055.55600Replenished 1001839075 3052306186
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781044 MR003185700107/09/202107/09/202107/10/202168001015400CARVEDILOL 6.25 MG TABLET6.25 MGTABLET100180105.55500Replenished 1001938284 3070173197
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781044 MR003185700107/09/202107/09/202107/10/202168001015400CARVEDILOL 6.25 MG TABLET6.25 MGTABLET1001807038.88900Replenished 1001888398 3061086532
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781044 MR003185700107/09/202107/09/202107/10/202168001015400CARVEDILOL 6.25 MG TABLET6.25 MGTABLET10018010055.55600Replenished 1001888398 3061086532
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781044 MR003185700210/08/202110/08/202110/09/202168001015400CARVEDILOL 6.25 MG TABLET6.25 MGTABLET1001803016.66700Replenished 1001938284 3070173197