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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 000000792356 MR000294760008/23/202208/23/202209/01/202200032301628CREON DR 36,000 UNIT CAPSULE36K-114KCAPSULE DR250250250100.00000Replenished 1002099459 3104747366
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794383 MR000294760011/22/202211/22/202212/03/202200032301628CREON DR 36,000 UNIT CAPSULE36K-114KCAPSULE DR250250250100.00000Replenished 1002142535 3114755271