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 000000791245 MR000182050007/01/202207/01/202207/02/202200054350049LIDOCAINE 2% VISCOUS SOLN2 %SOLUTION100100100100.00000Replenished 1002075849 3098184654
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795235 MR002408980001/04/202301/04/202301/05/202300054350049LIDOCAINE 2% VISCOUS SOLN2 %SOLUTION100100100100.00000Replenished 1002160525 3118886765