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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 000000787002 MR003446120101/18/202201/18/202201/19/202243547028010ESCITALOPRAM 5 MG TABLET5 MGTABLET100302583.33300Replenished 1002043399 3091212807
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000787002 MR003446120012/17/202112/17/202112/18/202143547028010ESCITALOPRAM 5 MG TABLET5 MGTABLET1003030100.00000Replenished 1002043399 3091212807
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000784639 MR003915800009/08/202109/09/202109/10/202143547028010ESCITALOPRAM 5 MG TABLET5 MGTABLET1004545100.00000Replenished 1002043399 3091212807