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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 000000788932 MR001174460003/15/202203/15/202203/16/202224208072002DEXAMETHASONE 0.1% EYE DROP0.1 %DROPS555100.00000Replenished 1002020152 3086903536
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784774 MR003691350009/14/202109/14/202109/15/202124208072002DEXAMETHASONE 0.1% EYE DROP0.1 %DROPS555100.00000Replenished 1001923412 3067730838
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780697 MR003466920003/22/202103/22/202103/23/202124208072002DEXAMETHASONE 0.1% EYE DROP0.1 %DROPS555100.00000Replenished 1001830087 3050733659