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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 000000796946 MR002091460307/03/202307/03/202307/04/202350742024830DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished07/06/2023 1002240234 3138951860
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000798901 MR002505580006/30/202306/30/202307/01/202350742024830DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H30903033.33300Replenished07/03/2023 1002239529 3138618794
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000798901 MR002505580006/30/202306/30/202307/01/202350742024830DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H30903033.33300Replenished07/03/2023 1002239529 3138618794
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000798901 MR002505580006/30/202306/30/202307/01/202350742024830DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H30903033.33400Replenished07/03/2023 1002239529 3138618794
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000799662 MR002091460008/10/202308/10/202308/11/202350742024830DILTIAZEM 24H ER(CD) 120 MG CP120 MGCAP.SR 24H303030100.00000Replenished08/14/2023 1002254688 3143269122