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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 000000792158 MR000415970008/12/202208/12/202208/13/202250742026101NIFEDIPINE ER 60 MG TABLET60 MGTAB ER2 241003030100.00000Replenished 1002164074 3119751775
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794404 MR000415970011/22/202211/22/202211/23/202250742026101NIFEDIPINE ER 60 MG TABLET60 MGTAB ER2 241003030100.00000Replenished 1002164074 3119751775
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794404 MR000415970112/15/202212/15/202212/16/202250742026101NIFEDIPINE ER 60 MG TABLET60 MGTAB ER2 241003030100.00000Replenished 1002164074 3119751775
Memorial Hospital**Trapp Pharmacy (#1)**Trapp Pharmacy (#1)Third Party – Captured 000000794404 MR000415970201/13/202301/13/202301/14/202350742026101NIFEDIPINE ER 60 MG TABLET60 MGTAB ER2 24100301033.33300Replenished 1002164074 3119751775