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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 000000795365 MR000294760001/09/202301/09/202301/10/202360258015001SF 5000 PLUS CREAM1.1 %CREAM(GM)515151100.00000Replenished 1002161832 3119403854
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000795365 MR000294760106/09/202306/09/202306/10/202360258015001SF 5000 PLUS CREAM1.1 %CREAM(GM)515151100.00000Replenished06/12/2023 1002232317 3136303176