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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 000000794615 MR000684920012/02/202212/02/202212/03/202231722077801ACYCLOVIR 800 MG TABLET800 MGTABLET1001515100.00000Replenished06/05/2023 1002226246 3135522746
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797430 MR002603410004/19/202304/19/202304/20/202331722077801ACYCLOVIR 800 MG TABLET800 MGTABLET1003030100.00000Replenished06/05/2023 1002226246 3135522746
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797813 MR002603410005/08/202305/08/202305/17/202331722077801ACYCLOVIR 800 MG TABLET800 MGTABLET1003030100.00000Replenished06/05/2023 1002226246 3135522746
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797813 MR002603410105/30/202305/30/202306/01/202331722077801ACYCLOVIR 800 MG TABLET800 MGTABLET100302583.33300Replenished06/05/2023 1002226246 3135522746