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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 000000779610 MR001340750002/02/202102/02/202102/03/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET100807695.00000Replenished 1001806279
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000793997 MR003951960403/20/202303/20/202303/21/202300093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET100301343.33300Replenished 1001806279
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000796526 MR002486460003/06/202303/06/202303/07/202300093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET100301136.66700Replenished 1001806279
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779610 MR001340750002/02/202102/02/202102/03/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1008045.00000Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779994 129680002/18/202102/18/202102/19/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1003030100.00000Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780189 MR000186700002/25/202102/25/202102/26/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1003030100.00000Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780189 MR000186700103/22/202103/22/202103/23/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET100302686.66700Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780637 MR001272790003/19/202103/19/202103/20/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1001010100.00000Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780189 MR000186700103/22/202103/22/202103/23/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET10030413.33300Replenished 1001897048 3062863316
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781480 MR000186700004/26/202104/26/202104/27/202100093171601WARFARIN SODIUM 4 MG TABLET4 MGTABLET1003030100.00000Replenished 1001897048 3062863316