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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 000000776888 MR001542460110/30/202010/30/202010/31/202068382009601HYDROXYCHLOROQUINE 200 MG TAB200 MGTABLET100601016.66700Replenished 1001839679 3052473904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776888 MR001542460110/30/202010/30/202010/31/202068382009601HYDROXYCHLOROQUINE 200 MG TAB200 MGTABLET100605083.33300Replenished 1001758407
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776888 MR001542460211/30/202011/30/202012/01/202068382009601HYDROXYCHLOROQUINE 200 MG TAB200 MGTABLET1006060100.00000Replenished 1001839679 3052473904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776888 MR001542460706/14/202106/14/202106/15/202168382009601HYDROXYCHLOROQUINE 200 MG TAB200 MGTABLET100602033.33300Replenished 1001916102 3066004378
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000776888 MR001542460706/14/202106/14/202106/15/202168382009601HYDROXYCHLOROQUINE 200 MG TAB200 MGTABLET100604066.66700Replenished 1001874393 3058663336
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779682 MR003154420204/08/202104/08/202104/09/202168382009601HYDROXYCHLOROQUINE 200 MG TAB200 MGTABLET1003030100.00000Replenished 1001839679 3052473904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779682 MR003154420305/04/202105/04/202105/05/202168382009601HYDROXYCHLOROQUINE 200 MG TAB200 MGTABLET1003030100.00000Replenished 1001874393 3058663336
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779682 MR003154420406/07/202106/07/202106/08/202168382009601HYDROXYCHLOROQUINE 200 MG TAB200 MGTABLET1003030100.00000Replenished 1001874393 3058663336
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779682 MR003154420507/09/202107/09/202107/10/202168382009601HYDROXYCHLOROQUINE 200 MG TAB200 MGTABLET1003030100.00000Replenished 1001916102 3066004378
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779682 MR003154420608/02/202108/02/202108/03/202168382009601HYDROXYCHLOROQUINE 200 MG TAB200 MGTABLET1003030100.00000Replenished 1001916102 3066004378