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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 000000779278 MR000050780102/10/202102/10/202102/11/202100168000615TRIAMCINOLONE 0.1% OINTMENT0.1 %OINT.(GM)151515100.00000Replenished 1001811232 987509358
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000790065 MR001825340005/06/202205/06/202205/07/202200168000615TRIAMCINOLONE 0.1% OINTMENT0.1 %OINT.(GM)151515100.00000Replenished 1002047220 3092154963
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000791792 MR002634430007/27/202207/27/202207/28/202200168000615TRIAMCINOLONE 0.1% OINTMENT0.1 %OINT.(GM)151515100.00000Replenished 1002084916 3100895806