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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 000004011409 55090004/21/202104/21/202104/22/202100591352430TESTOSTERONE 50 MG/5 GRAM GEL50 MG (1%)GEL (GRAM)150150150100.00000Replenished 1001846719 3053644953
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011547 MR001618810006/23/202106/23/202106/24/202100591352430TESTOSTERONE 50 MG/5 GRAM GEL50 MG (1%)GEL (GRAM)150150150100.00000Replenished 1001879330 3059650532
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011811 MR001618810010/18/202110/18/202110/19/202100591352430TESTOSTERONE 50 MG/5 GRAM GEL50 MG (1%)GEL (GRAM)15030015050.00000Replenished 1001945251 3071148262
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011811 MR001618810010/18/202110/18/202110/19/202100591352430TESTOSTERONE 50 MG/5 GRAM GEL50 MG (1%)GEL (GRAM)15030015050.00000Replenished 1001945251 3071148262