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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 000000776716 MR002290390102/11/202102/11/202102/12/202145802006535TRIAMCINOLONE 0.5% CREAM0.5 %CREAM(GM)151515100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000786779 MR002519070012/08/202112/08/202112/09/202145802006535TRIAMCINOLONE 0.5% CREAM0.5 %CREAM(GM)151515100.00000Replenished 1001970980 3076395348
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000789068 MR000620750003/21/202203/21/202203/22/202245802006535TRIAMCINOLONE 0.5% CREAM0.5 %CREAM(GM)151515100.00000Replenished 1002023985 3087397632