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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 000000797809 MR000876280005/08/202305/08/202305/17/202300168004015BETAMETHASONE VA 0.1% CREAM0.1 %CREAM(GM)151515100.00000Replenished05/19/2023 1002221549 3133876132
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797809 MR000876280107/05/202307/05/202307/06/202300168004015BETAMETHASONE VA 0.1% CREAM0.1 %CREAM(GM)151515100.00000Replenished08/22/2023 1002240777 3139104980
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000798367 MR001082060006/05/202306/05/202306/06/202300168004015BETAMETHASONE VA 0.1% CREAM0.1 %CREAM(GM)151515100.00000Replenished06/07/2023 1002227296 3135831552