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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 000000777476 MR001741360101/22/202101/22/202101/23/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA100908088.88900Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779266 MR003261530001/18/202101/18/202101/19/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA10090910.00000Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779830 MR001011130002/10/202102/10/202102/20/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA100301136.66700Replenished 1001814818 987756777
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774285 MR000919760502/08/202102/08/202102/09/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA1006060100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000777476 MR001741360101/22/202101/22/202101/23/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA100901011.11100Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000779778 MR002814350002/11/202102/11/202102/12/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA1003030100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000774285 MR000919760604/12/202104/12/202104/13/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA1006060100.00000Replenished 1001842802 3052853627
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780431 MR002814350104/13/202104/13/202104/14/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA100302170.00000Replenished 1001842802 3052853627
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781075 MR003261530004/08/202104/08/202104/09/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA100901921.11100Replenished 1001842802 3052853627
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000778109 MR001406320203/27/202103/27/202103/29/202168382039801POTASSIUM CL ER 20 MEQ TABLET20 MEQTABLET SA100902932.22200Replenished 1001839679 3052473904