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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 000000795640 MR003163140204/10/202304/10/202305/10/202300169255013TRESIBA FLEXTOUCH 200 UNIT/ML200/ML (3)INSULN PEN999100.00000Replenished05/12/2023 1002219463 3133122263
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000797879 MR003163140005/11/202305/11/202305/16/202300169255013TRESIBA FLEXTOUCH 200 UNIT/ML200/ML (3)INSULN PEN999100.00000Replenished05/18/2023 1002221191 3133750055
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000798478 MR003163140006/09/202306/09/202306/10/202300169255013TRESIBA FLEXTOUCH 200 UNIT/ML200/ML (3)INSULN PEN999100.00000Replenished06/12/2023 1002232317 3136303176