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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 000000772437 MR000952170912/28/202012/28/202012/29/202059746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000772437 MR000952171001/27/202101/27/202101/28/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000772437 MR000952171103/08/202103/08/202103/09/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001824202 3049524740
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780909 MR000952170003/31/202103/31/202104/01/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001849254 3054056168
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780909 MR000952170105/04/202105/04/202105/05/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001867724 3057523425
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780909 MR000952170206/01/202106/01/202106/02/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET10030516.66700Replenished 1001884259 3060456965
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780909 MR000952170206/01/202106/01/202106/02/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET100302583.33300Replenished 1001867724 3057523425
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780909 MR000952170307/01/202107/01/202107/02/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET10030516.66700Replenished 1001884259 3060456965
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780909 MR000952170307/01/202107/01/202107/02/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET100302583.33300Replenished 1001897770 3062993331
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780909 MR000952170407/29/202107/29/202107/30/202159746021601SPIRONOLACTONE 25 MG TABLET25 MGTABLET1003030100.00000Replenished 1001917809 3066693686