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 000000785333 MR001011130010/07/202110/07/202110/08/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET124250.00000Replenished 1001937905 3070173196
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785186 MR000255130009/30/202109/30/202110/01/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1211100.00000Replenished 1001937905 3070173196
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784945 MR000985750009/20/202109/20/202109/21/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1001937905 3070173196
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784671 MR000820700009/09/202109/09/202109/10/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1001937905 3070173196
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784401 MR002028490008/30/202108/30/202108/31/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1222100.00000Replenished 1001937905 3070173196
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783437 MR000620750007/20/202107/20/202107/21/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET127342.85700Replenished 1001937905 3070173196
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783437 MR000620750007/20/202107/20/202107/21/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET127457.14300Replenished 1001891615 3062304712
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783053 MR001697170007/02/202107/02/202107/03/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET1244100.00000Replenished 1001891615 3062304712
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782925 MR000620750006/28/202106/28/202106/29/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET127342.85700Replenished 1001882607 3060033992
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782925 MR000620750006/28/202106/28/202106/29/202168001025320FLUCONAZOLE 150 MG TABLET150 MGTABLET127457.14300Replenished 1001891615 3062304712