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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 000000774986 MR002109290203/08/202103/08/202103/09/202168001041100GABAPENTIN 600 MG TABLET600 MGTABLET100902022.22200Replenished 1001828208 3050330142
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774986 MR002109290203/08/202103/08/202103/09/202168001041100GABAPENTIN 600 MG TABLET600 MGTABLET100907077.77800Replenished 1001823796 3049396293
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774986 MR002109290305/24/202105/24/202105/25/202168001041100GABAPENTIN 600 MG TABLET600 MGTABLET100902022.22200Replenished 1001882607 3060033992
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774986 MR002109290305/24/202105/24/202105/25/202168001041100GABAPENTIN 600 MG TABLET600 MGTABLET100907077.77800Replenished 1001863873 3056827847
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779589 MR001715220002/01/202102/01/202102/02/202168001041100GABAPENTIN 600 MG TABLET600 MGTABLET1001803016.66700Replenished 1001805758
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779589 MR001715220002/01/202102/01/202102/02/202168001041100GABAPENTIN 600 MG TABLET600 MGTABLET1001805027.77800Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779589 MR001715220002/01/202102/01/202102/02/202168001041100GABAPENTIN 600 MG TABLET600 MGTABLET10018010055.55500Replenished 1001805758
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780264 MR001715220003/01/202103/01/202103/02/202168001041100GABAPENTIN 600 MG TABLET600 MGTABLET1001803016.66600Replenished 1001823796 3049396293
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780264 MR001715220003/01/202103/01/202103/02/202168001041100GABAPENTIN 600 MG TABLET600 MGTABLET1001805027.77800Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780264 MR001715220003/01/202103/01/202103/02/202168001041100GABAPENTIN 600 MG TABLET600 MGTABLET10018010055.55600Replenished 1001819373 988099025