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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 000000780629 MR002257040108/13/202108/13/202108/14/202162175011937ISOSORBIDE MONONIT ER 60 MG TB60 MGTAB.SR 24H100901011.11100Replenished 1001903802 3064589183
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000780629 MR002257040003/18/202103/18/202103/19/202162175011937ISOSORBIDE MONONIT ER 60 MG TB60 MGTAB.SR 24H1009090100.00000Replenished 1001903802 3064589183