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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 000000783002 MR003284060108/03/202108/03/202108/13/202100173088710TRELEGY ELLIPTA 100-62.5-25100-62.5DISK W/DEV606060100.00000Replenished 1001903802 3064589183
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783002 MR003284060209/07/202109/07/202109/17/202100173088710TRELEGY ELLIPTA 100-62.5-25100-62.5DISK W/DEV606060100.00000Replenished 1001924089 3068049380
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785580 MR003284060010/18/202110/18/202110/30/202100173088710TRELEGY ELLIPTA 100-62.5-25100-62.5DISK W/DEV606060100.00000Replenished 1001951026 3072312986
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786849 MR003891670012/13/202112/13/202112/14/202100173088710TRELEGY ELLIPTA 100-62.5-25100-62.5DISK W/DEV606060100.00000Replenished 1001973568 3076863124
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786849 MR003891670101/10/202201/10/202201/11/202200173088710TRELEGY ELLIPTA 100-62.5-25100-62.5DISK W/DEV606060100.00000Replenished 1001988245 3079745989
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000796167 MR001847900002/16/202302/16/202302/17/202300173088710TRELEGY ELLIPTA 100-62.5-25100-62.5DISK W/DEV606060100.00000Replenished 1002179601 3123877801