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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 000000775112 14440201/21/202101/21/202101/22/202165862047701RAMIPRIL 10 MG CAPSULE10 MGCAPSULE1001804022.22200Replenished 1001800027
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775112 14440201/21/202101/21/202101/22/202165862047701RAMIPRIL 10 MG CAPSULE10 MGCAPSULE1001804022.22200Replenished 1001848263 3053810034
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775112 14440201/21/202101/21/202101/22/202165862047701RAMIPRIL 10 MG CAPSULE10 MGCAPSULE10018010055.55600Replenished 1001800027
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775112 14440304/23/202104/23/202104/24/202165862047701RAMIPRIL 10 MG CAPSULE10 MGCAPSULE1001802011.11100Replenished 1001892297 3062473633
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775112 14440304/23/202104/23/202104/24/202165862047701RAMIPRIL 10 MG CAPSULE10 MGCAPSULE1001806033.33300Replenished 1001848263 3053810034
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000775112 14440304/23/202104/23/202104/24/202165862047701RAMIPRIL 10 MG CAPSULE10 MGCAPSULE10018010055.55600Replenished 1001848263 3053810034
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783493 14440007/22/202107/22/202107/23/202165862047701RAMIPRIL 10 MG CAPSULE10 MGCAPSULE1001808044.44400Replenished 1001892297 3062473633
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783493 14440007/22/202107/22/202107/23/202165862047701RAMIPRIL 10 MG CAPSULE10 MGCAPSULE10018010055.55600Replenished 1001892297 3062473633