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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 000000797868 MR003951960005/19/202305/19/202305/20/202300228212810CLONIDINE HCL 0.2 MG TABLET0.2 MGTABLET1006060100.00000Replenished08/18/2023 1002260285 3143898442
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797868 MR003951960106/20/202306/20/202306/21/202300228212810CLONIDINE HCL 0.2 MG TABLET0.2 MGTABLET100604066.66700Replenished08/18/2023 1002260285 3143898442