Back

Accumulator - View By Claim

Export to Excel

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 000000775906 MR002000110203/05/202103/05/202103/06/202168180052001LISINOPRIL-HCTZ 20-25 MG TAB20 MG-25MGTABLET100451533.33300Replenished 1001822785 3049139689
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775906 MR002000110203/05/202103/05/202103/06/202168180052001LISINOPRIL-HCTZ 20-25 MG TAB20 MG-25MGTABLET100453066.66700Replenished 1001849254 3054056168
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775906 MR002000110306/04/202106/04/202106/05/202168180052001LISINOPRIL-HCTZ 20-25 MG TAB20 MG-25MGTABLET1004545100.00000Replenished 1001885854 3060825455
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778744 MR003894840012/22/202012/22/202012/23/202068180052001LISINOPRIL-HCTZ 20-25 MG TAB20 MG-25MGTABLET100602541.66700Replenished 1001782104
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778744 MR003894840012/22/202012/22/202012/23/202068180052001LISINOPRIL-HCTZ 20-25 MG TAB20 MG-25MGTABLET100603558.33300Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778744 MR003894840102/19/202102/19/202102/20/202168180052001LISINOPRIL-HCTZ 20-25 MG TAB20 MG-25MGTABLET100602033.33300Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778744 MR003894840102/19/202102/19/202102/20/202168180052001LISINOPRIL-HCTZ 20-25 MG TAB20 MG-25MGTABLET100604066.66700Replenished 1001822785 3049139689
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778744 MR003894840204/26/202104/26/202104/27/202168180052001LISINOPRIL-HCTZ 20-25 MG TAB20 MG-25MGTABLET100602541.66700Replenished 1001849254 3054056168
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778744 MR003894840204/26/202104/26/202104/27/202168180052001LISINOPRIL-HCTZ 20-25 MG TAB20 MG-25MGTABLET100603558.33300Replenished 1001885854 3060825455
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778744 MR003894840307/06/202107/06/202107/07/202168180052001LISINOPRIL-HCTZ 20-25 MG TAB20 MG-25MGTABLET100602033.33300Replenished 1001885854 3060825455