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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 000000779485 MR000186700102/24/202102/24/202102/25/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001816771 988000091
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779485 MR000186700203/22/202103/22/202103/23/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001830087 3050733659
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779485 MR000186700304/26/202104/26/202104/27/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001849254 3054056168
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779485 MR000186700405/26/202105/26/202105/27/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001864958 3056990723
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779485 MR000186700506/29/202106/29/202106/30/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001883113 3060162693
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779485 MR000186700607/27/202107/27/202107/28/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001897048 3062863316
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779485 MR000186700708/26/202108/26/202108/27/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001911378 3066004376
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779485 MR000186700809/27/202109/27/202109/28/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001928804 3069023028
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779485 MR000186700910/28/202110/28/202110/29/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001951026 3072312986
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779485 MR000186701011/24/202111/24/202111/25/202124979002606DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished 1001963864 3074997377