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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 000000781999 MR000760600005/17/202105/17/202105/18/202100228278011PROPRANOLOL ER 120 MG CAPSULE120 MGCAP.SA 24H1009090100.00000Replenished 1001936140 3069865653
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781999 MR000760600110/05/202110/05/202110/06/202100228278011PROPRANOLOL ER 120 MG CAPSULE120 MGCAP.SA 24H100901011.11100Replenished 1001936140 3069865653
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781999 MR000760600110/05/202110/05/202110/06/202100228278011PROPRANOLOL ER 120 MG CAPSULE120 MGCAP.SA 24H100908088.88900Replenished 1001984164 3079004486
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000781999 MR000760600201/03/202201/03/202201/04/202200228278011PROPRANOLOL ER 120 MG CAPSULE120 MGCAP.SA 24H100902022.22200Replenished 1001984164 3079004486