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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 000000794724 MR000255130103/13/202303/13/202303/14/202372888003001OXYBUTYNIN CL ER 5 MG TABLET5 MGTAB ER2 24100908088.88900Replenished06/29/2023 1002238604 3138299994
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794724 MR000255130206/27/202306/27/202306/28/202372888003001OXYBUTYNIN CL ER 5 MG TABLET5 MGTAB ER2 24100902022.22200Replenished06/29/2023 1002238604 3138299994
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794724 MR000255130012/08/202212/08/202212/09/202272888003001OXYBUTYNIN CL ER 5 MG TABLET5 MGTAB ER2 241009090100.00000Replenished 1002188313 3126619593
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794724 MR000255130103/13/202303/13/202303/14/202372888003001OXYBUTYNIN CL ER 5 MG TABLET5 MGTAB ER2 24100901011.11100Replenished 1002188313 3126619593