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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 000000791712 MR001982700007/25/202207/25/202207/26/202264679092602ENALAPRIL MALEATE 20 MG TAB20 MGTABLET1003030100.00000Replenished 1002096808 3104187393
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000792405 MR001982700008/24/202208/24/202208/25/202264679092602ENALAPRIL MALEATE 20 MG TAB20 MGTABLET1003030100.00000Replenished 1002096808 3104187393