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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 000000784925 MR001746970306/13/202206/13/202206/14/202268001051800POTASSIUM CL ER 10 MEQ TABLET10 MEQTABLET SA1009090100.00000Replenished 1002067998 3096617326
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786656 MR000247430204/27/202204/27/202204/28/202268001051800POTASSIUM CL ER 10 MEQ TABLET10 MEQTABLET SA100601016.66700Replenished 1002043831 3091402520
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786656 MR000247430204/27/202204/27/202204/28/202268001051800POTASSIUM CL ER 10 MEQ TABLET10 MEQTABLET SA100605083.33300Replenished 1002050928 3092714512
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787945 MR002897470106/22/202206/22/202206/23/202268001051800POTASSIUM CL ER 10 MEQ TABLET10 MEQTABLET SA1001804022.22200Replenished 1002072694 3097384160
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787945 MR002897470106/22/202206/22/202206/23/202268001051800POTASSIUM CL ER 10 MEQ TABLET10 MEQTABLET SA1001804022.22200Replenished 1002073100 3097384162
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787945 MR002897470106/22/202206/22/202206/23/202268001051800POTASSIUM CL ER 10 MEQ TABLET10 MEQTABLET SA10018010055.55600Replenished 1002072694 3097384160
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787945 MR002897470209/15/202209/15/202209/16/202268001051800POTASSIUM CL ER 10 MEQ TABLET10 MEQTABLET SA1001808044.44400Replenished 1002108257 3106376963
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787945 MR002897470209/15/202209/15/202209/16/202268001051800POTASSIUM CL ER 10 MEQ TABLET10 MEQTABLET SA10018010055.55600Replenished 1002108257 3106376963
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788154 MR003404930002/07/202202/07/202202/08/202268001051800POTASSIUM CL ER 10 MEQ TABLET10 MEQTABLET SA1003030100.00000Replenished 1002043831 3091402520
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000788154 MR003404930103/07/202203/07/202203/08/202268001051800POTASSIUM CL ER 10 MEQ TABLET10 MEQTABLET SA1003030100.00000Replenished 1002043831 3091402520