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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 000000779479 MR001778440103/08/202103/08/202103/09/202100093720198PRAVASTATIN SODIUM 20 MG TAB20 MGTABLET903030100.00000Replenished 1001851763 3054766187
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779479 MR001778440204/05/202104/05/202104/07/202100093720198PRAVASTATIN SODIUM 20 MG TAB20 MGTABLET903030100.00000Replenished 1001851763 3054766187
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781625 MR001778440005/03/202105/03/202105/04/202100093720198PRAVASTATIN SODIUM 20 MG TAB20 MGTABLET903030100.00000Replenished 1001851763 3054766187
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779577 MR002771770105/04/202105/04/202105/05/202100093720198PRAVASTATIN SODIUM 20 MG TAB20 MGTABLET909090100.00000Replenished 1001852121 3054859692
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779577 MR002771770208/09/202108/09/202108/10/202100093720198PRAVASTATIN SODIUM 20 MG TAB20 MGTABLET90906066.66700Replenished 1001902393 3064140711
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000782441 MR001778440006/07/202106/07/202106/08/202100093720198PRAVASTATIN SODIUM 20 MG TAB20 MGTABLET903030100.00000Replenished 1001902393 3064140711
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779577 MR002771770208/09/202108/09/202108/10/202100093720198PRAVASTATIN SODIUM 20 MG TAB20 MGTABLET90903033.33300Replenished 1001951777 3072578295
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785919 MR002771770011/01/202111/01/202111/02/202100093720198PRAVASTATIN SODIUM 20 MG TAB20 MGTABLET90906066.66700Replenished 1001951777 3072578295
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000785919 MR002771770011/01/202111/01/202111/02/202100093720198PRAVASTATIN SODIUM 20 MG TAB20 MGTABLET90903033.33300Replenished 1001992840 3080996426
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787805 MR001520150001/20/202201/20/202201/21/202200093720198PRAVASTATIN SODIUM 20 MG TAB20 MGTABLET90906066.66700Replenished 1001992840 3080996426