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 000000774929 MR001709230006/01/202106/01/202106/02/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR10018021.11100Replenished 1001871163 3057980095
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774929 MR001709230006/01/202106/01/202106/02/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1001803821.11100Replenished 1001867724 3057523425
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774929 MR001709230006/01/202106/01/202106/02/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1001804022.22200Replenished 1001867724 3057523425
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774929 MR001709230006/01/202106/01/202106/02/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR10018010055.55600Replenished 1001867724 3057523425
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779707 MR002239180002/05/202102/05/202102/06/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR1009022.22300Replenished 1001816056 987916714
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779707 MR002239180002/05/202102/05/202102/06/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100904044.44400Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779707 MR002239180002/05/202102/05/202102/06/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100904853.33300Replenished 1001807887
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779821 M8KG365D0002/10/202102/10/202102/11/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100902022.22200Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779821 M8KG365D0002/10/202102/10/202102/11/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100903033.33400Replenished 1001816056 987916714
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779821 M8KG365D0002/10/202102/10/202102/11/202168462039601OMEPRAZOLE DR 20 MG CAPSULE20 MGCAPSULE DR100904044.44400Replenished 1001811232 987509358