Back

Accumulator - View By Claim

Export to Excel

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 000000778288 MR001842770003/12/202103/12/202103/13/202172618300002NURTEC ODT 75 MG TABLET75 MGTAB RAPDIS888100.00000Replenished 1001825961 3049810904