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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 000000774285 MR000919760502/08/202102/08/202102/09/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA1006060100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774285 MR000919760604/12/202104/12/202104/13/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA1006060100.00000Replenished 1001842802 3052853627
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777476 MR001741360101/22/202101/22/202101/23/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA100901011.11100Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777476 MR001741360101/22/202101/22/202101/23/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA100908088.88900Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778109 MR001406320203/27/202103/27/202103/29/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA100902932.22200Replenished 1001839679 3052473904
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778109 MR001406320203/27/202103/27/202103/29/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA100906167.77800Replenished 1001833898 3051271129
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778337 MR002588990103/16/202103/16/202103/17/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA1001802916.11100Replenished 1001831820 3050993427
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778337 MR002588990103/16/202103/16/202103/17/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA1001805128.33300Replenished 1001827193 3050193216
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778337 MR002588990103/16/202103/16/202103/17/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA10018010055.55600Replenished 1001827193 3050193216
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778606 M8KG365D0103/24/202103/24/202103/25/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA1001803921.66600Replenished 1001833898 3051271129