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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 000004011847 MR003888620011/04/202111/04/202111/05/202110702002501PHENTERMINE 37.5 MG TABLET37.5 MGTABLET1003030100.00000Replenished 1001993531 3080996428
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011895 MR003888620012/01/202112/01/202112/02/202110702002501PHENTERMINE 37.5 MG TABLET37.5 MGTABLET1003030100.00000Replenished 1001993531 3080996428
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011924 MR003888620012/24/202112/24/202112/25/202110702002501PHENTERMINE 37.5 MG TABLET37.5 MGTABLET1003030100.00000Replenished 1001993531 3080996428
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000004011996 MR003888620001/22/202201/22/202201/23/202210702002501PHENTERMINE 37.5 MG TABLET37.5 MGTABLET100301033.33300Replenished 1001993531 3080996428