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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 000000779099 MR000952171011/18/202111/18/202111/19/202170710121001ALLOPURINOL 300 MG TABLET300 MGTABLET1003030100.00000Replenished 1001963534 3074872858
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779099 MR000952171112/21/202112/21/202112/22/202170710121001ALLOPURINOL 300 MG TABLET300 MGTABLET1003030100.00000Replenished 1001981624 3078485431
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781409 MR001174460311/16/202111/16/202111/17/202170710121001ALLOPURINOL 300 MG TABLET300 MGTABLET1003030100.00000Replenished 1001963534 3074872858
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781409 MR001174460412/20/202112/20/202112/21/202170710121001ALLOPURINOL 300 MG TABLET300 MGTABLET1003030100.00000Replenished 1001981624 3078485431
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781409 MR001174460501/19/202201/19/202201/20/202270710121001ALLOPURINOL 300 MG TABLET300 MGTABLET1003030100.00000Replenished 1001992840 3080996426
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781409 MR001174460602/21/202202/21/202202/22/202270710121001ALLOPURINOL 300 MG TABLET300 MGTABLET1003030100.00000Replenished 1002008728 3084278400
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781409 MR001174460703/18/202203/18/202203/19/202270710121001ALLOPURINOL 300 MG TABLET300 MGTABLET1003030100.00000Replenished 1002030231 3088464249
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781409 MR001174460804/15/202204/15/202204/16/202270710121001ALLOPURINOL 300 MG TABLET300 MGTABLET1003030100.00000Replenished 1002037486 3090307729
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783883 MR002980170311/23/202111/23/202111/24/202170710121001ALLOPURINOL 300 MG TABLET300 MGTABLET100301033.33300Replenished 1001963534 3074872858
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000783883 MR002980170311/23/202111/23/202111/24/202170710121001ALLOPURINOL 300 MG TABLET300 MGTABLET100302066.66700Replenished 1001981624 3078485431