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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 000000771886 MR001918890702/22/202102/22/202102/23/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100903842.22200Replenished 1001816056 987916714
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000771886 MR001918890702/22/202102/22/202102/23/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100905257.77800Replenished 1001816393 987952822
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000773542 MR001709230803/05/202103/05/202103/06/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100601016.66700Replenished 1001822785 3049139689
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000773542 MR001709230803/05/202103/05/202103/06/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100602236.66600Replenished 1001824202 3049524740
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000773542 MR001709230803/05/202103/05/202103/06/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100602846.66700Replenished 1001822785 3049139689
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000773542 MR001709230904/05/202104/05/202104/07/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1006060100.00000Replenished 1001839075 3052306186
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000773542 MR001709231005/07/202105/07/202105/08/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1006023.33300Replenished 1001856282 3055381317
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000773542 MR001709231005/07/202105/07/202105/08/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100605896.66700Replenished 1001855254 3055135221
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774556 MR002420680803/01/202103/01/202103/02/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR10030826.66700Replenished 1001819373 988099025
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774556 MR002420680803/01/202103/01/202103/02/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100301033.33300Replenished 1001819373 988099025