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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 000000798674 MR003892430208/25/202308/25/202308/26/202343547035210LISINOPRIL 5 MG TABLET5 MGTABLET100301033.33300Replenished08/28/2023 1002263052 3144881029
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000799763 MR000050230008/16/202308/16/202308/17/202343547035210LISINOPRIL 5 MG TABLET5 MGTABLET1009090100.00000Replenished08/28/2023 1002263052 3144881029