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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) 00378117591BUSPIRONE HCL 30 MG TABLET30 MGTABLET600600.00000Suspended 1002068507 3096751040
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505252906ZIPRASIDONE HCL 40 MG CAPSULE40 MGCAPSULE600600.00000Suspended 1001024027
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 60505253006ZIPRASIDONE HCL 60 MG CAPSULE60 MGCAPSULE600600.00000Suspended 1001326094
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68001011707LEVETIRACETAM 500 MG TABLET500 MGTABLET1200600.00000Suspended 1001602316
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 68001041100GABAPENTIN 600 MG TABLET600 MGTABLET1000600.00000Suspended08/29/2023 1002261840 3144399971
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 69097096607NABUMETONE 750 MG TABLET750 MGTABLET1000600.00000Suspended 1001805758
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00069046903CHANTIX 1 MG CONT MONTH BOX1 MGTABLET560560.00000Suspended 1001597272
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 49884015676VARENICLINE 1 MG TABLET1 MGTABLET560560.00000Returned Suspended 1002068256 3096617328
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 00193731150CONTOUR NEXT TEST STRIPSTRIP500500.00000Suspended 1002010073 3084421077
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1) 53885024450ONETOUCH ULTRA TEST STRIPSTRIP500500.00000Suspended 1002138927 3113726124