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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 000000779348 MR003195940506/25/202106/28/202106/29/202168001047100METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1001906178 3065115185
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783298 MR001797270007/13/202107/13/202107/14/202168001047100METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1001906178 3065115185
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783564 MR003195940007/26/202107/26/202107/27/202168001047100METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1001906178 3065115185
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784171 MR001797270008/18/202108/18/202108/19/202168001047100METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H100301033.33300Replenished 1001906178 3065115185
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784171 MR001797270008/18/202108/18/202108/19/202168001047100METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H100302066.66700Replenished 1001948371 3071858707
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784301 MR003195940008/25/202108/25/202108/26/202168001047100METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1001948371 3071858707
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784863 MR003195940009/18/202109/18/202109/19/202168001047100METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H1003030100.00000Replenished 1001948371 3071858707
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784863 MR003195940110/25/202110/25/202110/26/202168001047100METOPROLOL SUCC ER 200 MG TAB200 MGTAB.SR 24H100302066.66700Replenished 1001948371 3071858707